Outcomes and risk stratification for late antibody-mediated rejection in recipients of ABO-incompatible kidney transplants: a retrospective study
| Autor: | Dorry L. Segev, Niraj M. Desai, Sunjae Bae, Nada Alachkar, Adnan Sharif, Robert A. Montgomery, Fizza F. Naqvi, Nabil N. Dagher, Karen E. King, Edward S. Kraus, Mary Jo Holechek, Bonnie E. Lonze |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty 030232 urology & nephrology 030230 surgery Risk Assessment ABO Blood-Group System Isoantibodies 03 medical and health sciences 0302 clinical medicine HLA Antigens Risk Factors ABO blood group system Internal medicine Outcome Assessment Health Care Living Donors medicine Humans Kidney transplantation Aged Retrospective Studies Transplantation Models Statistical business.industry Incidence Incidence (epidemiology) Retrospective cohort study Middle Aged medicine.disease Kidney Transplantation Surgery Titer Blood Group Incompatibility Cohort Female business Follow-Up Studies |
| Zdroj: | Transplant International. 30 |
| ISSN: | 0934-0874 |
| DOI: | 10.1111/tri.12969 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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