OUTCOMES OF CHRONIC ANTIBODY MEDIATED REJECTION IN KIDNEY TRANSPLANT RECIPIENTS

Introduction:

Chronic Antibody Mediated Rejection (c-ABMR) is a leading cause of kidney allograft failure and loss in kidney transplant recipients (KTRs). Transplant glomerulopathy is the hallmark of chronic endothelial injury in transplant kidney biopsies, characterised by glomerular basement membrane reduplication and absence of immune-complex deposits. Due to limited availability of biomarkers for early detection and lack of satisfactory therapies, real-world management of c-ABMR poses significant challenges with a direct impact on allograft and patient survival. The clinical impact of c-ABMR on outcomes in developing countries is not well known. In the light of rapidly emerging novel biomarkers and targeted therapies in management of kidney transplant rejection, there is an undeniable need to understand more about clinical course and outcomes of c-ABMR.

Methods:

39 patients with biopsy proven c-ABMR were included in this study and data was obtained retrospectively from clinical history and out-patient clinic records of KTRs. The study aimed to examine demography, risk factors, clinical features and treatment strategies employed in patients diagnosed with c-ABMR and to study its effect on allograft and patient related outcomes and survival. 

Results:

36 (92.3%) were living donor KTRs. Majority were males (87.2%). Mean time to diagnosis of chronic-ABMR was 108.10 (67.23) months. 9 (23.08%) had prior biopsy proven acute rejection episodes. Peak proteinuria and peak serum creatinine value at diagnosis of c-ABMR were 2.23 (2.42) gms/day and 2.14 (0.72) mg/dl respectively. 15 (38.5%) had chronic active ABMR. 4 (13.3%) had concomitant acute cellular rejection. All patients were treated by increasing doses of one or more immunosuppressive agents. Mean time of follow up after diagnosis of chronic-ABMR was 30.33 (39.85) months. 33 (84.62%) patients experienced opportunistic infections (OIs) after treatment of chronic-ABMR, with 20 (60.6%) of these experiencing >1 OI. Mean allograft survival after diagnosis of c-ABMR was 29.2 (39.7) months. 10 (25.64%) had allograft failure. Mean patient survival after diagnosis of c-ABMR was 32.2 (40.4) months. 17 (43.59%) of patients died, 10 (25.6%) died with a functioning allograft. Peak serum creatinine >2mg/dl (0.016) and higher Banff ‘cg’ score on kidney biopsy (0.009) were found to be predictive for kidney allograft failure. Higher peak proteinuria (>2gm/day) was found to be predictive for mortality (0.041).

Conclusions:

Chronic-ABMR is an important cause of poor allograft outcomes after kidney transplantation and contributes significantly to patient morbidity and mortality. There is an urgent need of effective and widely utilisable strategies for early detection and management for improving overall outcomes in kidney transplantation. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.