Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for Chronic Rejection After Treatment of Active Antibody-Mediated Rejection

• DOI: 10.3389/ti.2024.11960
• Publication Date: 2024-02-02T04:11:21Z
• Authors: Taro Banno; Toshihito Hirai; Rikako Oki; Takafumi Yagisawa; Kohei Unagami; Taichi Kanzawa; Kazuya Omoto; Tomokazu Shimizu; Hideki Ishida; Toshio Takagi
• Keywords: Plasmapheresis; Regimen; Panel reactive antibody

Recent developments in intensive desensitization protocols have enabled kidney transplantation human leukocyte antigen (HLA)-sensitized recipients. However, cases of active antibody-mediated rejection (AABMR), when they occur, are difficult to manage, graft failure being the worst-case scenario. We aimed assess impact our and AABMR treatment regimen identify risk factors for disease progression. Among 849 patients who underwent living-donor between 2014 2021 at institution, 59 were diagnosed with within 1 year after transplantation. All received combination therapy consisting steroid pulse therapy, intravenous immunoglobulin, rituximab, plasmapheresis. Multivariable analysis revealed unrelated donors preformed donor-specific antibodies as independent AABMR. Five-year death-censored survival rate was not significantly different without although 27 developed chronic (CABMR) during study period. Multivariate Cox proportional hazard regression that a donor age greater than years microvascular inflammation (MVI) score (g + ptc) ≥4 diagnosis CABMR. Our ameliorated AABMR; however, further options should be considered prevent CABMR, especially old severe MVI.