Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection
Recent developments in intensive desensitization protocols have enabled kidney transplantation in human leukocyte antigen (HLA)-sensitized recipients. However, cases of active antibody-mediated rejection (AABMR), when they occur, are difficult to manage, graft failure being the worst-case scenario....
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Transplant International |
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| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/ti.2024.11960/full |
| _version_ | 1797221079360471040 |
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| author | Taro Banno Toshihito Hirai Rikako Oki Takafumi Yagisawa Kohei Unagami Taichi Kanzawa Kazuya Omoto Tomokazu Shimizu Hideki Ishida Toshio Takagi |
| author_facet | Taro Banno Toshihito Hirai Rikako Oki Takafumi Yagisawa Kohei Unagami Taichi Kanzawa Kazuya Omoto Tomokazu Shimizu Hideki Ishida Toshio Takagi |
| author_sort | Taro Banno |
| collection | DOAJ |
| description | Recent developments in intensive desensitization protocols have enabled kidney transplantation in human leukocyte antigen (HLA)-sensitized recipients. However, cases of active antibody-mediated rejection (AABMR), when they occur, are difficult to manage, graft failure being the worst-case scenario. We aimed to assess the impact of our desensitization and AABMR treatment regimen and identify risk factors for disease progression. Among 849 patients who underwent living-donor kidney transplantation between 2014 and 2021 at our institution, 59 were diagnosed with AABMR within 1 year after transplantation. All patients received combination therapy consisting of steroid pulse therapy, intravenous immunoglobulin, rituximab, and plasmapheresis. Multivariable analysis revealed unrelated donors and preformed donor-specific antibodies as independent risk factors for AABMR. Five-year death-censored graft survival rate was not significantly different between patients with and without AABMR although 27 of 59 patients with AABMR developed chronic AABMR (CABMR) during the study period. Multivariate Cox proportional hazard regression analysis revealed that a donor age greater than 59 years and microvascular inflammation (MVI) score (g + ptc) ≥4 at AABMR diagnosis were independent risk factors for CABMR. Our combination therapy ameliorated AABMR; however, further treatment options should be considered to prevent CABMR, especially in patients with old donors and severe MVI. |
| first_indexed | 2024-04-24T12:59:44Z |
| format | Article |
| id | doaj.art-6ef93194911943f996b7d30db34fbff1 |
| institution | Directory Open Access Journal |
| issn | 1432-2277 |
| language | English |
| last_indexed | 2024-04-24T12:59:44Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Transplant International |
| spelling | doaj.art-6ef93194911943f996b7d30db34fbff12024-04-05T16:19:56ZengFrontiers Media S.A.Transplant International1432-22772024-02-013710.3389/ti.2024.1196011960Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated RejectionTaro Banno0Toshihito Hirai1Rikako Oki2Takafumi Yagisawa3Kohei Unagami4Taichi Kanzawa5Kazuya Omoto6Tomokazu Shimizu7Hideki Ishida8Toshio Takagi9Department of Urology, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Urology, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Organ Transplant Medicine, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Urology, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Organ Transplant Medicine, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Urology, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Urology, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Organ Transplant Medicine, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Organ Transplant Medicine, Tokyo Women’s Medical University Hospital, Tokyo, JapanDepartment of Urology, Tokyo Women’s Medical University Hospital, Tokyo, JapanRecent developments in intensive desensitization protocols have enabled kidney transplantation in human leukocyte antigen (HLA)-sensitized recipients. However, cases of active antibody-mediated rejection (AABMR), when they occur, are difficult to manage, graft failure being the worst-case scenario. We aimed to assess the impact of our desensitization and AABMR treatment regimen and identify risk factors for disease progression. Among 849 patients who underwent living-donor kidney transplantation between 2014 and 2021 at our institution, 59 were diagnosed with AABMR within 1 year after transplantation. All patients received combination therapy consisting of steroid pulse therapy, intravenous immunoglobulin, rituximab, and plasmapheresis. Multivariable analysis revealed unrelated donors and preformed donor-specific antibodies as independent risk factors for AABMR. Five-year death-censored graft survival rate was not significantly different between patients with and without AABMR although 27 of 59 patients with AABMR developed chronic AABMR (CABMR) during the study period. Multivariate Cox proportional hazard regression analysis revealed that a donor age greater than 59 years and microvascular inflammation (MVI) score (g + ptc) ≥4 at AABMR diagnosis were independent risk factors for CABMR. Our combination therapy ameliorated AABMR; however, further treatment options should be considered to prevent CABMR, especially in patients with old donors and severe MVI.https://www.frontierspartnerships.org/articles/10.3389/ti.2024.11960/fullantibody-mediated rejectionBanff classificationgraft survivalkidney transplantationtreatment outcomes |
| spellingShingle | Taro Banno Toshihito Hirai Rikako Oki Takafumi Yagisawa Kohei Unagami Taichi Kanzawa Kazuya Omoto Tomokazu Shimizu Hideki Ishida Toshio Takagi Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection Transplant International antibody-mediated rejection Banff classification graft survival kidney transplantation treatment outcomes |
| title | Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection |
| title_full | Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection |
| title_fullStr | Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection |
| title_full_unstemmed | Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection |
| title_short | Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection |
| title_sort | higher donor age and severe microvascular inflammation are risk factors for chronic rejection after treatment of active antibody mediated rejection |
| topic | antibody-mediated rejection Banff classification graft survival kidney transplantation treatment outcomes |
| url | https://www.frontierspartnerships.org/articles/10.3389/ti.2024.11960/full |
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