INCIDENCE AND PROGNOSIS OF ANTIBODY-MEDIATED REJECTION IN KIDNEY ALLOGRAFTS

THE STUDY was aimed to define the incidence rate and outcomes of antibody-mediated rejection (AMR) in the routine morphological and immunological monitoring. PATIENTS AND METHODS. 55 recipients of kidney allograft (KA) were enrolled into the study according to inclusion criteria (AB0-compatibility, negative cytotoxic crossmatch, minimum 3 kidnеy allograft biopsies in posttransplant period). All patients were on standard immunosuppressive regimen: glucocorticosteroids, basiliximab, calcineurin inhibitors, mycophenolate mofetil. Protocol (on 3, 6, 12 months and then annually) and indicative (delayed graft function, increase of serum creatinine level of ≥25%, proteinuria ≥1 g/24h) KA biopsies were evaluated according to Banff classification 2013. Enzyme-linked immunosorbent and multiplex (Luminex; xMAP Technology) assays were applied for donor-specific antibodies screening and monitoring, respectively. The treatment of AMR included glucocorticosteroids, plasma exchange, intravenous immunoglobulin, rituximab, bortesomib. KA loss and return to dialysis were defined as an outcome. Long-term KA prognosis was estimated by Kaplan–Meier survival analysis. The median posttransplant follow-up was 65 (47; 80) months. RESULTS. Morphological features of AMR was established in 13% of biopsies (n=390) and 45% of patients met Banff 2013 AMR criteria. Acute AMR (aAMR) and chronic active (cAMR) were found in 13 and 12 KA recipients, respectively. 48% of cases showed subclinical type of AMR. Persistence and chronification of AMR were established in 56% and 77% of patients, respectively. Cumulative 9-year patient survival in the group studied (n=55) for the follow-up period was 94,5%, cumulative survival of KA was 79%. KA survival was worse in AMR patients when compared with the control group without AMR (73% vs 100%, plog-rank=0,016). There were no difference in KA survival in aAMR and cAMR as far as in clinical and subclinical types of AMR. CONCLUSION: AMR is supposed to be the frequent and under-recognized clinical problem associated with inferior KA survival and overall effectiveness of kidney allotransplantation. The approach to early diagnostic and treatment of this type of immune conflict requires the immunological and morphological monitoring of КА on a regular basis.

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