title: Outcomes and risk stratification for late antibody-mediated rejection in recipients of ABO-incompatible kidney transplants: a retrospective study.
abstract: The required intensity of monitoring for antibody-mediated rejection (AMR) after of ABO-incompatible (ABOi) kidney transplantation is not clearly formulized. We retrospectively evaluated a single-center cohort of 115 ABO-incompatible (ABOi) kidney transplant recipients, of which 32% were also HLA incompatible (ABOi/HLAi) with their donors. We used an adjusted negative binomial model to evaluate risk factors for late AMR. Using this model, we risk-stratified patients into high- and low-risk groups for the development of late AMR; 26% of patients had at least one AMR episode; 49% of AMR episodes occurred within 30-days after transplant and were considered early AMR. Patients with an early AMR episode had a 5.5-fold greater incidence of developing late AMR [IRR = 5.5, (95% CI: 1.5-19.3), P = 0.01]. ABOi/HLAi recipients trended toward increased late AMR risk [IRR = 1.9, (95% CI: 0.5-6.6), P = 0.3]. High-risk recipients (those with an early AMR or those who were ABOi/HLAi) had a sixfold increased incidence of late AMR [IRR = 6.3, (95% CI: 1.6-24.6), P = 0.008] versus low-risk recipients. The overall incidence of late AMR was 20.8% vs. 1.5% in low-risk recipients. Changes in anti-A/B titer did not correlate with late AMR (IRR = 0.9 per log titer increase, P = 0.7). This risk-stratification scheme uses information available within 30 days of ABOi transplantation to determine risk for late AMR and can help direct longitudinal follow-up for individual patients.
authors.affiliation: Transplant Institute, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Bonnie E
authors.identifier: http://orcid.org/0000-0002-0973-1657
authors.initials: BE
authors.lastname: Lonze
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sunjae
authors.initials: S
authors.lastname: Bae
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kraus
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Holechek
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: King
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nada
authors.initials: N
authors.lastname: Alachkar
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Fizza F
authors.initials: FF
authors.lastname: Naqvi
authors.affiliation: Transplant Institute, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Nabil N
authors.initials: NN
authors.lastname: Dagher
authors.affiliation: Department of Nephrology and Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sharif
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Niraj M
authors.initials: NM
authors.lastname: Desai
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, MD, USA.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Transplant Institute, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007518:Isoantibodies
keywords: ABO-incompatible; antibody-mediated rejection; kidney transplantation