Increased C4d in post-reperfusion biopsies and increased donor specific antibodies at one-week post transplant are risk factors for acute rejection in mild to moderately sensitized kidney transplant recipients
Arjang Djamali, Brenda L Muth, Thomas M Ellis, Maha Mohamed, Luis A Fernandez, Karen M Miller, Janet M Bellingham, Jon S Odorico, Joshua D Mezrich, John D Pirsch, Tony M D'Alessandro, Vijay Vidyasagar, R Michael Hofmann, Jose R Torrealba, Dixon B Kaufman, David P Foley, Arjang Djamali, Brenda L Muth, Thomas M Ellis, Maha Mohamed, Luis A Fernandez, Karen M Miller, Janet M Bellingham, Jon S Odorico, Joshua D Mezrich, John D Pirsch, Tony M D'Alessandro, Vijay Vidyasagar, R Michael Hofmann, Jose R Torrealba, Dixon B Kaufman, David P Foley
Abstract
In order to define the intensity of immunosuppression, we examined risk factors for acute rejection in desensitization protocols that use baseline donor-specific antibody levels measured as mean fluorescence intensity (MFImax). The study included 146 patients transplanted with a negative flow crossmatch and a mean follow-up of 18 months with the majority (83%) followed for at least 1 year. At the time of transplant, mean-calculated panel-reactive antibody and MFImax ranged from 10.3-57.2% and 262-1691, respectively, between low- and high-risk protocols. Mean MFImax increased significantly from transplant to 1 week and 1 year. The incidence of acute rejection (mean 1.65 months) as a combination of clinical and subclinical rejection was 32%, including 14% cellular, 12% antibody-mediated, and 6% mixed rejection. In regression analyses, only C4d staining in post-reperfusion biopsies (hazard ratio 3.3, confidence interval 1.71-6.45) and increased specific antibodies at 1-week post transplant were significant predictors of rejection. A rise in MFImax by 500 was associated with a 2.8-fold risk of rejection. Thus, C4d staining in post-reperfusion biopsies and an early rise in donor specific antibodies after transplantation are risk factors for rejection in moderately sensitized patients.
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References
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Source: PubMed