Characteristics of Early Antibody Mediated Rejection in Antibody Incompatible Living Donor Kidney Transplantation.

Autor:	Punjala SR; Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Ibrahim M; Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Phillips BL; Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Stojanovic J; Department of Pediatric Nephrology and Transplantation, Great Ormond Street Hospital, London, United Kingdom., Kessaris N; Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.; Department of Pediatric Nephrology and Transplantation, Great Ormond Street Hospital, London, United Kingdom.; Department of Pediatric Nephrology and Transplantation, Evelina Children's Hospital, London, United Kingdom., Shaw O; Clinical Transplantation Lab, Viapath, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Dorling A; Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.; Department of Inflammation Biology, King's College London, London, United Kingdom., Mamode N; Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.; Department of Pediatric Nephrology and Transplantation, Evelina Children's Hospital, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Transplant international : official journal of the European Society for Organ Transplantation [Transpl Int] 2024 Jul 08; Vol. 37, pp. 12942. Date of Electronic Publication: 2024 Jul 08 (Print Publication: 2024).
DOI:	10.3389/ti.2024.12942
Abstrakt:	Antibody incompatible transplantation (AIT) may be an only option for highly sensitized patients. Severe form of early antibody mediated rejection (AMR) adversely affects graft survival after AIT. The aim of this study was to identify individuals at risk of AMR. We analyzed 213 living donor AITs performed at our center. Among 120 ABOi, 58 HLAi and 35 DSA + FCXM-negative cases, the rates of early AMR were 6%, 31%, and 9%, respectively ( p < 0.001). On multivariate analysis for graft loss, early AMR had a HR of 3.28 ( p < 0.001). The HLAi group had worse death-censored graft survival ( p = 0.003). In the HLAi group, Patients with aggressive variant AMR (AAMR) had greater percentage of C3d complement fixing DSA, higher baseline class I and total DSA MFI levels and B-cell FCXM RMF. C1q and C3d complement fixing DSA and strong positivity of baseline B- or T-cell FXCM as predictors of AAMR had 100% sensitivity. Early AMR is of significant clinical concern in AIT as it results in poor graft survival and is not well described in literature. An aggressive variant is characterized by massive rise in DSA levels at rejection. Baseline DSA, C1q, and C3d and baseline FCXM values can be used to risk-stratify candidates for AIT. Competing Interests: Author AD is a consultant for Hansa Biopharma, and is on the scientific advisory board for Verici Dx Ltd. Author NM receives honoraria from Hansa Biopharma, Takeda and Novartis. The rest of the author(s) of this study have no involvements that might raise the question of bias in the work reported or in the conclusions, implications, or opinions stated. Author OS was employed by Viapath. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Punjala, Ibrahim, Phillips, Stojanovic, Kessaris, Shaw, Dorling and Mamode.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu