The Analysis of Graft Outcomes Following Treatment in Chronic Antibody-Mediated Rejection in Kidney Transplantation

Abstract

Background: The chronic antibody-mediated rejection (CAMR) has been known to be a detrimental factor for poor graft outcomes in kidney transplantation (KT) recipients. We have treated the recipients with CAMR and attempted to find out the condition affecting the treatment response. Methods: Patients who underwent kidney transplantation and were treated for CAMR, diagnosed with ultrasonography-guided needle biopsy, crossmatch or panel reactive anti-body by 07' Banff classification, and followed up more than 6 months, were enrolled in this study. Recipients with CAMR were treated with plamapheresis and rituximab. Results: Between December 2007 and November 2011, a total of 18 patients with CAMR were treated with plasmapheresis and rituximab administration (500mg I.V.) and followed more than 6 months. Donor was a living donor in 10 recipients, and a deceased donor in 8. Interval between KT and diagnosis of CAMR was a median of 108.5 months post-transplantation (range 55˜219). Serum creatinine at the time of diagnosis of CAMR was a median of 3.8 mg/dL (range, 1.5˜14.3). Eight of the 18 recipients underwent graft failure after 6 months following diagnosis of CAMR in spite of treatment. Six out of 10 recipients with graft function at 6 months post-treatment maintained their graft function at a median follow-up of 15.5 months post-treatment (range, 6˜36) with a median of serum Cr 2.65 mg/dL (range, 1.4˜5.6). Regarding the factors affecting the response following treatment in CAMR, delta Cr (difference of level of Cr between the time of diagnosis and 6 months prior to diagnosis) was a median of 1.0 mg/dL in 10 recipients with functioning graft at 6 months post-treatment and 4.2 mg/dL in 8 with graft loss (p=0.055 by Mann-Whitney U test). Conclusions: Although the treatment outcomes of CAMR were disappointing, some recipients, with small delta Cr maintained stable graft function after 6 months post-treatment. Even in the recipients with CAMR treatment against humoral response should be tried accordingly. Further evaluation for the treatment in CAMR should be performed in large scale of patient pool.