title: The effect of histopathologic and clinical features on allograft survival in renal transplant patients with antibody-mediated rejection.
abstract: BACKGROUND
  Antibody-mediated rejection is a frequent cause of graft failure; however, prognostic indications of this complication have not been well defined. The aim of this study was to evaluate the association of histopathological and clinical features and to determine the effect of these findings on allograft survival in patients with AMR.
  
  
  METHODS
  Fifty-two patients suffered from AMR (30 male; mean age 39 ± 11 years) were included in the study. Data were investigated retrospectively and graft survival was analyzed. All transplant biopsies were evaluated according to Banff 2009 classification.
  
  
  RESULTS
  Of the 52 cases, 45 were transplanted from living-donors. Twenty-one patients were diagnosed in the first 3-months after transplantation. Graft survival was 65% at 12 months and 54% at 36 months. Mean serum creatinine at time of biopsy was 3.8 ± 3.6 mg/dL. Thirty-five of the 52 cases showed diffuse C4d positivity, 12 cases showed focal and 5 remained C4d negative. One of the patients died, 13 experienced graft loss and 38 survived with functioning grafts. Serum creatinine levels at time of biopsy were correlated with graft survival (p = .021: OR = 1.10: 95 % CI = 1.015-1.199). In terms of the impact of pathological findings; tubulitis (p=.007: OR = 2.62: 95 % CI = 1.301-5.276), intimal arteritis (p=.017: OR = 2.85: 95% CI = 1.205-6.744) and interstitial infiltration (p=.004: OR = 3.37: 95% CI = 1.465-7.752) were associated with graft survival.
  
  
  CONCLUSIONS
  Serum creatinine at time of biopsy, tubulitis, intimal arteritis and interstitial infiltration were significantly associated with graft survival. Antibody-mediated rejection is associated with reduced long-term graft survival.
authors: a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors: Tulin
authors: T
authors: Akagun
authors: a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors: Halil
authors: H
authors: Yazici
authors: a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors: Yasar
authors: Y
authors: Caliskan
authors: b Department of Pathology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors: Yasemin
authors: Y
authors: Ozluk
authors: c Nephrology Clinic , Acibadem Atakent Hospital , Istanbul , Turkey.
authors: Sevgi
authors: S
authors: Sahin
authors: a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors: Aydin
authors: A
authors: Turkmen
authors: b Department of Pathology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors: Isın
authors: I
authors: Kılıcaslan
authors: a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
authors: Mehmet Sukru
authors: MS
authors: Sever
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood*; D001706:Biopsy; D015935:Complement C4b / Q000276:immunology*; D003404:Creatinine / Q000097:blood*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014421:Turkey
chemical_list: D000906:Antibodies; D015935:Complement C4b; D003404:Creatinine
keywords: Renal transplantation; allograft survival; antibody-mediated rejection; serum creatinine; transplant biopsy