17 November 2020 : Original article
Treatment of Antibody-Mediated Rejection After Kidney Transplantation: Immunological Effects, Clinical Response, and Histological Findings
Marcos Vinicius de Sousa1ABCDEF*, Ana Claudia Gonçalez2CD, Ricardo de Lima Zollner3DE, Marilda Mazzali1ADEDOI: 10.12659/AOT.925488
Ann Transplant 2020; 25:e925488
Table 1 General characteristics of the kidney transplant recipients who underwent treatment for biopsy-proven antibody-mediated rejection (AMR).
| Transplant recipientes | |
|---|---|
| Total, n | 42 |
| Age (years) | 36.4±12.6 |
| Male, n (%) | 22 (52.3) |
| Etiology of CKD (%) | |
| Chronic glomerulonephritis | 19 (45.2) |
| Unknown | 12 (28.6) |
| Systemic arterial hypertension | 4 (9.5) |
| Diabetes mellitus | 1 (2.4) |
| Others | 6 (14.3) |
| Transfusions pre transplant, n (%) | 22 (52.4) |
| Previous transplantation, n (%) | 5 (11.9) |
| Women with pre transplant pregnancies, n (%) | 9 (45.0) |
| HLA ABDR Mismatches | 3.9±1.1 |
| Pre transplant Class I PRA (%) | 14.6±25.2 |
| Pre transplant Class II PRA (%) | 11.1±25.2 |
| Preformed DSA, n (%) | 8 (19.0) |
| Preformed non-DSA, n (%) | 16 (38.1) |
| Deceased donors, n (%) | 37 (88.1) |
| Age (years) | 34.9±14.9 |
| Male, n (%) | 21 (50.0) |
| Expanded criteria donors (%) | 6 (14.3) |
| Serum creatinine (mg/dl) | 1.3±1.1 |
| KDPI index (%) | 43.1±28.8 |
| Initial immunosuppressive therapy | |
| Antithymocyte (%) | 16 (38.1) |
| Antithymocyte dose (mg/kg) | 5.8±1.2 |
| IL-2 receptor (%) | 22 (52.4) |
| Cold ischemia (hours) | 21.2±6.5 |
| DGF, n (%) | 10 (23.8) |
| Time post-transplant (months) | 27.2 (0.3–213.0) |
| AMR ≤24 months, n (%) | 19 (45.2) |
| AMR >24 months, n (%) | 23 (54.8) |
| CNI at diagnosis, n (%) | 32 (76.2) |
| IVIG, n (%) | 38 (90.5) |
| PP, n (%) | 26 (61.9) |
| Antithymocyte, n (%) | 8 (19.0) |
| Steroid pulse therapy, n (%) | 17 (40.5) |
| n – number; CKD – chronic kidney disease; HLA – human leukocyte antigen; PRA – panel reactive antibody; DSA – donor specific anti-HLA antibody; KDPI – kidney donor profile index; DGF – delayed graft function; AMR – antibody-mediated rejection; CNI – calcineurin inhibitor; IVIG – intravenous immunoglobulin; PP – plasmapheresis. | |