title: Current outcomes of chronic active antibody mediated rejection - A large single center retrospective review using the updated BANFF 2013 criteria.
abstract: BACKGROUND
  The updated BANFF 2013 criteria has enabled a more standardized and complete serologic and histopathologic diagnosis of chronic active antibody mediated rejection (cAMR). Little data exists on the outcomes of cAMR since the initiation of this updated criteria.
  
  
  METHODS
  123 consecutive patients with biopsy proven cAMR (BANFF 2013) between 2006 and 2012 were identified.
  
  
  RESULTS
  Patients identified with cAMR were followed for a median of 9.5 (2.7-20.3) years after transplant and 4.3 (0-8.8) years after cAMR. Ninety-four (76%) recipients lost their grafts with a median survival of 1.9 years after diagnosis with cAMR. Mean C4d and allograft glomerulopathy scores were 2.6 ± 0.7 and 2.2 ± 0.8, respectively. 53.2% had class II DSA, 32.2% had both class I and II, and 14.5% had class I DSA only. Chronicity score >8 (HR 2.9, 95% CI 1-8.4, p=0.05), DSA >2500 MFI (HR 2.8, 95% CI 1.1-6.8, p=0.03), Scr >3mg/dL (HR 3.2, 95% CI 1.6-6.3, p=0.001) and UPC >1g/g (HR 2.5, 95% CI 1.4-4.5, p=0.003) were associated with a higher risk of graft loss.
  
  
  CONCLUSIONS
  cAMR was associated with poor graft survival after diagnosis. Improved therapies and earlier detection strategies are likely needed to improve outcomes of cAMR in kidney transplant recipients.
authors: Division of Transplantation, Department of Surgery, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States. Electronic address: rrredfield@wisc.edu.
authors: Robert R
authors: RR
authors: Redfield
authors: HLA Laboratory, Department of Pathology, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Thomas M
authors: TM
authors: Ellis
authors: Department of Pathology, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Weixiong
authors: W
authors: Zhong
authors: Division of Transplantation, Department of Surgery, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Joseph R
authors: JR
authors: Scalea
authors: Department of Surgery, University of Wisconsin - Madison School of Medicine an and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Tiffany J
authors: TJ
authors: Zens
authors: Division of Nephrology, Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Didier
authors: D
authors: Mandelbrot
authors: Division of Nephrology, Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Brenda L
authors: BL
authors: Muth
authors: Division of Nephrology, Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Sarah
authors: S
authors: Panzer
authors: Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, United States.
authors: Millie
authors: M
authors: Samaniego
authors: Division of Transplantation, Department of Surgery, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Dixon B
authors: DB
authors: Kaufman
authors: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States.
authors: Brad C
authors: BC
authors: Astor
authors: Division of Transplantation, Department of Surgery, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States; Division of Nephrology, Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
authors: Arjang
authors: A
authors: Djamali
mesh_terms: D000920:Antibody-Dependent Cell Cytotoxicity; D001706:Biopsy; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D063868:Patient Outcome Assessment
chemical_list: D007518:Isoantibodies
keywords: Chronic Allograft Rejection; Outcomes; Renal transplantation