title: Older kidney transplant patients experience less antibody-mediated rejection: a retrospective study of patients with mild to moderate sensitization.
abstract: BACKGROUND
  There is a paucity of data stratifying by age the incidence of antibody-mediated rejection (AMR) in kidney transplant patients.
  
  
  METHODS
  We performed a retrospective study of all adult, renal transplant recipients at a single institution between December 12, 2009, and March 16, 2011. Mildly and moderately sensitized patients were defined as patients with positive donor-specific antibody (DSA) and negative flow cross-match.
  
  
  RESULTS
  One hundred and forty-six patients were determined to have mild to moderate pre-transplantation sensitization. Thirty percent of patients younger than 40 yr of age experienced AMR vs. 15% in the older group (p = 0.04). There was a disproportionate increase in DSA for younger patients at 12 months, particularly for antibodies to class II. Histologic presence of C4d deposition was independently associated with AMR on multivariate analysis.
  
  
  CONCLUSIONS
  Following renal transplantation, moderately sensitized patients aged 40 yr old and older were less likely to develop AMR when compared with younger patients.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Scalea
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Muth
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: Maha
authors.initials: M
authors.lastname: Mohamed
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Wilson
authors.affiliation: Department of Surgery, HLA Laboratory, University of Wisconsin, Madison, WI, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Ellis
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Dixon B
authors.initials: DB
authors.lastname: Kaufman
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors
chemical_list: D007518:Isoantibodies
keywords: B cell senescence; T cell senescence; antibody mediated rejection; elderly; rejection in aged patients