IMPROVED KIDNEY ALLOGRAFT SURVIVAL FOLLOWING REPEATED ANTI-REJECTION THERAPY IN PATIENTS WITH ANTIBODY-MEDIATED REJECTION AND PERSISTENT MICROVASCULAR INFLAMMATION UNDER ACTIVE HISTOLOGICAL SURVEILLANCE

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https://storage.unitedwebnetwork.com/files/1099/d975cfd7d0e1903b93f37a1118f0a16f.pdf

Abstract Title *

IMPROVED KIDNEY ALLOGRAFT SURVIVAL FOLLOWING REPEATED ANTI-REJECTION THERAPY IN PATIENTS WITH ANTIBODY-MEDIATED REJECTION AND PERSISTENT MICROVASCULAR INFLAMMATION UNDER ACTIVE HISTOLOGICAL SURVEILLANCE

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Co-author 1

Erick Yasar Zuñiga Gonzalez yasareyzg@gmail.com Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán Department of Nephrology and Mineral Bone Metabolism Mexico City Mexico *

Co-author 2

Luis Agustin Camacho Murillo luiscamachomurillo@gmail.com Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán Department of Nephrology and Mineral Bone Metabolism Mexico City Mexico -

Co-author 3

Norma Ofelia Uribe Uribe nofeliauribe@yahoo.com.mx Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán Department of Pathology Mexico City Mexico -

Co-author 4

Lluvia Aurora Marino Vazquez lluvia.marino@gmail.com Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán Department of Nephrology and Mineral Bone Metabolism Mexico City Mexico -

Co-author 5

Luis Eduardo Morales Buenrostro luis_buenrostro@yahoo.com Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán Department of Nephrology and Mineral Bone Metabolism Mexico City Mexico -

Co-author 6

Co-author 7

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Introduction

Antibody-mediated rejection (AMR) remains the leading cause of kidney allograft loss. Persistent inflammation on follow-up biopsies after anti-rejection therapy has been associated with worse outcomes. This study evaluated the impact of performing post-treatment biopsies and applying targeted re-treatment on graft survival.

Methods

We conducted a single-center retrospective cohort study (2011–2023) including kidney transplant recipients with AMR who underwent follow-up biopsies within 12 months after treatment, compared with a control group (no re-biopsy). All patients received standard anti-rejection therapy (steroids, plasma exchange, intravenous immunoglobulin, and/or rituximab). Persistent microvascular inflammation (MVI) guided the decision for a new treatment course. Graft survival was analyzed according to group, histologic response, and re-treatment.

Results

A total of 230 patients with AMR were included (159 re-biopsied; 71 controls), comprising 569 evaluated biopsies. Median time from transplant to AMR diagnosis was 63 months in controls versus 52 months in the re-biopsy group. Graft survival at 60 months was higher among re-biopsied patients (82% vs. 66%) [Figure 1A]. Among those re-biopsied, only 61 (38%) achieved resolution of MVI (g+ptc < 1), which was associated with improved prognosis [Figure 1B]. In patients with persistent MVI, re-treatment was associated with better graft survival [Figure 1C], without differences in AMR recurrence [Figure 1D].

Conclusion

A follow-up biopsy strategy provides prognostic value and identifies patients with persistent inflammation who benefit from re-treatment. This approach is associated with improved kidney allograft survival, supporting the use of active histologic monitoring in the management of AMR.

Kewords