PMID- 38371907
OWN - NLM
STAT- MEDLINE
DCOM- 20240220
LR  - 20240307
IS  - 1432-2277 (Electronic)
IS  - 0934-0874 (Print)
IS  - 0934-0874 (Linking)
VI  - 37
DP  - 2024
TI  - Higher Donor Age and Severe Microvascular Inflammation Are Risk Factors for 
      Chronic Rejection After Treatment of Active Antibody-Mediated Rejection.
PG  - 11960
LID - 10.3389/ti.2024.11960 [doi]
LID - 11960
AB  - Recent developments in intensive desensitization protocols have enabled kidney 
      transplantation in 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 to 
      assess the impact of our desensitization and AABMR treatment regimen and identify 
      risk factors for disease progression. Among 849 patients who underwent 
      living-donor kidney transplantation between 2014 and 2021 at our institution, 59 
      were diagnosed with AABMR within 1 year after transplantation. All patients 
      received combination therapy consisting of steroid pulse therapy, intravenous 
      immunoglobulin, rituximab, and plasmapheresis. Multivariable analysis revealed 
      unrelated donors and preformed donor-specific antibodies as independent risk 
      factors for AABMR. Five-year death-censored graft survival rate was not 
      significantly different between patients with and without AABMR although 27 of 59 
      patients with AABMR developed chronic AABMR (CABMR) during the study period. 
      Multivariate Cox proportional hazard regression analysis revealed that a donor 
      age greater than 59 years and microvascular inflammation (MVI) score (g + ptc) >/=4 
      at AABMR diagnosis were independent risk factors for CABMR. Our combination 
      therapy ameliorated AABMR; however, further treatment options should be 
      considered to prevent CABMR, especially in patients with old donors and severe 
      MVI.
CI  - Copyright (c) 2024 Banno, Hirai, Oki, Yagisawa, Unagami, Kanzawa, Omoto, Shimizu, 
      Ishida and Takagi.
FAU - Banno, Taro
AU  - Banno T
AD  - Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
FAU - Hirai, Toshihito
AU  - Hirai T
AD  - Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
FAU - Oki, Rikako
AU  - Oki R
AD  - Department of Organ Transplant Medicine, Tokyo Women's Medical University 
      Hospital, Tokyo, Japan.
FAU - Yagisawa, Takafumi
AU  - Yagisawa T
AD  - Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
FAU - Unagami, Kohei
AU  - Unagami K
AD  - Department of Organ Transplant Medicine, Tokyo Women's Medical University 
      Hospital, Tokyo, Japan.
FAU - Kanzawa, Taichi
AU  - Kanzawa T
AD  - Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
FAU - Omoto, Kazuya
AU  - Omoto K
AD  - Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
FAU - Shimizu, Tomokazu
AU  - Shimizu T
AD  - Department of Organ Transplant Medicine, Tokyo Women's Medical University 
      Hospital, Tokyo, Japan.
FAU - Ishida, Hideki
AU  - Ishida H
AD  - Department of Organ Transplant Medicine, Tokyo Women's Medical University 
      Hospital, Tokyo, Japan.
FAU - Takagi, Toshio
AU  - Takagi T
AD  - Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20240202
PL  - Switzerland
TA  - Transpl Int
JT  - Transplant international : official journal of the European Society for Organ 
      Transplantation
JID - 8908516
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - *Antibodies
MH  - *Kidney Transplantation/adverse effects/methods
MH  - Kidney
MH  - Risk Factors
MH  - Inflammation/etiology
MH  - Graft Rejection
MH  - Graft Survival
MH  - HLA Antigens
PMC - PMC10869508
OTO - NOTNLM
OT  - Banff classification
OT  - antibody-mediated rejection
OT  - graft survival
OT  - kidney transplantation
OT  - treatment outcomes
COIS- The 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.
EDAT- 2024/02/19 06:42
MHDA- 2024/02/20 11:57
PMCR- 2024/02/02
CRDT- 2024/02/19 04:33
PHST- 2023/08/24 00:00 [received]
PHST- 2024/01/10 00:00 [accepted]
PHST- 2024/02/20 11:57 [medline]
PHST- 2024/02/19 06:42 [pubmed]
PHST- 2024/02/19 04:33 [entrez]
PHST- 2024/02/02 00:00 [pmc-release]
AID - 11960 [pii]
AID - 10.3389/ti.2024.11960 [doi]
PST - epublish
SO  - Transpl Int. 2024 Feb 2;37:11960. doi: 10.3389/ti.2024.11960. eCollection 2024.