Introduction:
Antibody mediated rejection (ABMR) also termed humoral rejection is one of the most important causes of allograft dysfunction. Active ABMR clinically occur within few months of transplantation and present with acute renal failure or oliguria that may be severe enough to require dialysis. Clinically chronic active ABMR patients present with chronic renal dysfunction with proteinuria. This study aim to analyse clinical profile and outcome of biopsy proven ABMR among renal allograft recipients (RAR).
Methods:
This was a retrospective observational study carried out over a course of 2 years in the department of Nephrology among RAR with biopsy proven ABMR. Records were reviewed and analysed from 1st January 2022 to 30th December 2023. A total of 17 patients were listed for the study.
Results:
Incidence of ABMR was found to be 12.3%. 23.5% patients had acute ABMR while 76.5% patients had chronic active ABMR. Mean duration for acute ABMR was 3.2 months whereas for chronic ABMR it was 2.6 years. Renal dysfunction (100%), Oliguria (64.7%) followed by leg swelling (47.1%) were most common clinical manifestation. Most common risk factor for ABMR was poor drug compliance (70.5%) followed by infections (52.9%). Three patients with acute ABMR were treated with plasmapheresis and intravenous immunoglobulin (IVIG) as anti-rejection therapy whereas the fourth patient received plasmapheresis with IVIG followed by rituximab. Four out of thirteen patients of chronic active ABMR were treated with plasmapheresis and IVIG while nine patients were treated with IVIG alone. Immunosuppressants were modified accordingly in each patients. Patients survival was 94.1% after 6 months of follow-up whereas graft survival was 50% in acute ABMR and 61.5% in chronic active ABMR.
Conclusions:
In our study majority of the patients presented with chronic ABMR and poor drug compliance being the most common risk factor. Most of the patient with chronic active ABMR responded to anti-rejection therapy with significant improvement in graft function. ABMR can be responsive to anti-rejection therapy if it is intervened timely.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.