Characteristics of Early Antibody Mediated Rejection in Antibody Incompatible Living Donor Kidney Transplantation

Transplant International Pub Date : 2024-07-08 DOI:10.3389/ti.2024.12942

S. Punjala, Maria Ibrahim, Benedict L. Phillips, Jelena Stojanovic, N. Kessaris, O. Shaw, Anthony Dorling, N. Mamode

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Abstract

Antibody incompatible transplantation (AIT) may be an only option for highly sensitized patients. Severe form of early antibody mediated rejection (AMR) adversely affects graft survival after AIT. The aim of this study was to identify individuals at risk of AMR. We analyzed 213 living donor AITs performed at our center. Among 120 ABOi, 58 HLAi and 35 DSA + FCXM-negative cases, the rates of early AMR were 6%, 31%, and 9%, respectively (p < 0.001). On multivariate analysis for graft loss, early AMR had a HR of 3.28 (p < 0.001). The HLAi group had worse death-censored graft survival (p = 0.003). In the HLAi group, Patients with aggressive variant AMR (AAMR) had greater percentage of C3d complement fixing DSA, higher baseline class I and total DSA MFI levels and B-cell FCXM RMF. C1q and C3d complement fixing DSA and strong positivity of baseline B- or T-cell FXCM as predictors of AAMR had 100% sensitivity. Early AMR is of significant clinical concern in AIT as it results in poor graft survival and is not well described in literature. An aggressive variant is characterized by massive rise in DSA levels at rejection. Baseline DSA, C1q, and C3d and baseline FCXM values can be used to risk-stratify candidates for AIT.

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抗体不相容活体供肾移植中早期抗体介导排斥反应的特征

抗体不相容移植（AIT）可能是高度致敏患者的唯一选择。严重的早期抗体介导排斥反应（AMR）会对 AIT 后的移植物存活率产生不利影响。本研究的目的是确定有发生 AMR 风险的个体。我们分析了在本中心进行的 213 例活体供体 AIT。在 120 例 ABOi、58 例 HLAi 和 35 例 DSA + FCXM 阴性病例中，早期 AMR 的发生率分别为 6%、31% 和 9%（P < 0.001）。根据移植物丢失的多变量分析，早期 AMR 的 HR 为 3.28（P < 0.001）。HLAi 组的死亡剪除移植物存活率更低（p = 0.003）。在HLAi组中，侵袭性变异AMR（AAMR）患者的C3d补体固定DSA比例更高，基线I类和总DSA MFI水平以及B细胞FCXM RMF更高。C1q和C3d补体固定DSA以及基线B细胞或T细胞FXCM的强阳性作为AAMR的预测因子，其敏感性为100%。在 AIT 中，早期 AMR 会导致移植物存活率低下，而且文献中对其描述并不详尽，因此在临床上备受关注。一种侵袭性变异的特征是排斥反应时 DSA 水平大幅升高。基线 DSA、C1q、C3d 和基线 FCXM 值可用于对 AIT 候选者进行风险分级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Transplant International

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