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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 Mazzali1ADE

DOI: 10.12659/AOT.925488

Ann Transplant 2020; 25:e925488

Table 3 Histopathological findings at diagnosis of antibody-mediated rejection (AMR) and after treatment.

GeneralAMR ≤24 months post-TxAMR >24 months post-Tx
At AMRAfter treatmentpAt AMRAfter treatmentpAt AMRAfter treatmentp
Number of graft biopsies, n (%)42 (100.0)30 (71.4)19 (100.0)10 (52.6)23 (100.0)20 (66.7)
Time (months)39.6±43.8* 2.4±3.0** 6.7±7.22.9±3.466.9±42.72.2±2.9
Glomerular sclerosis (%)11.0±20.716.4±21.90.29# 2.8±4.81.8±5.50.60# 17.8±26.023.8±23.50.44#
Banff score
 i (0 to 3)1.0±0.80.5±0.6# 0.8±0.70.7±0.70.22# 1.3±0.90.6±0.6#
 t (0 to 3)1.0±0.90,7±0.90.15# 0.7±0.91.0±1.30.45# 1.3±0.90.5±0.6#
 v (0 to 3)0.1±0.40.0±0.00.16# 0.2±0.60.0±0.00.36# 0.1±0.30.0±0.00.32#
 g (0 to 3)1.1±0.80.8±1.00.25# 0.8±0.80.4±0.50.16# 1.3±0.81.0±1.20.38#
 ptc (0 to 3)1.6±1.01.3±0.90.15# 1.2±1.21.1±1.10.81# 1.9±0.71.3±0.90.02#
 MVI g + ptc (0 to 6)2.6±1.72.0±1.80.18# 1.9±1.81.4±1.20.39# 3.2±1.42.4±1.90.13#
 C4d (0 to 3)2.2±1.01.4±1.2# 1.8±1.21.0±1.00.12# 2.5±0.81.5±1.3#
 ci (0 to 3)1.0±0.91.4±1.00.17# 0.6±0.71.2±0.90.07# 1.4±0.81.4±1.00.94#
 ct (0 to 3)1.2±0.91.5±0.90.10# 0.8±0.81.5±0.70.03# 1.5±0.81.5±0.90.93#
Electron microscopy, n (%)
 IC deposits7 (16.7)2 (6.2)0.76## 3 (15.8)1 (10.0)0.99## 4 (17.4)2 (10.0)0.97##
 Podocyte effacement10 (23.8)3 (9.4)0.62## 4 (21.0)2 (20.0)>0.99## 6 (26.1)3 (15.0)0.93##
 GBM duplication7 (16.7)3 (9.4)0.93## 2 (10.5)1 (10.0)>0.99## 5 (21.7)5 (25.0)0.99##
AMR – antibody-mediated rejection; i – inflammation; t – tubulitis; v – intimal arteritis; g – glomerulitis; ptc – peritubular capillaritis; MVI – microvascular inflammation; ci – interstitial fibrosis; ct – tubular atrophy; IC – immune complex; GBM – glomerular basement membrane.
* Time post-transplant;
** time post-AMR treatment;
# unpaired t-test;
## Chi-square test.

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358