Abstract
In order to define the intensity of immunosuppression, we examined risk factors for acute rejection in desensitization protocols that use baseline donor-specific antibody levels measured as mean fluorescence intensity (MFI max). The study included 146 patients transplanted with a negative flow crossmatch and a mean follow-up of 18 months with the majority (83%) followed for at least 1 year. At the time of transplant, mean-calculated panel-reactive antibody and MFI max ranged from 10.3-57.2% and 262-1691, respectively, between low-and high-risk protocols. Mean MFI max increased significantly from transplant to 1 week and 1 year. The incidence of acute rejection (mean 1.65 months) as a combination of clinical and subclinical rejection was 32%, including 14% cellular, 12% antibody-mediated, and 6% mixed rejection. In regression analyses, only C4d staining in post-reperfusion biopsies (hazard ratio 3.3, confidence interval 1.71-6.45) and increased specific antibodies at 1-week post transplant were significant predictors of rejection. A rise in MFI max by 500 was associated with a 2.8-fold risk of rejection. Thus, C4d staining in post-reperfusion biopsies and an early rise in donor specific antibodies after transplantation are risk factors for rejection in moderately sensitized patients.
Original language | English (US) |
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Pages (from-to) | 1185-1192 |
Number of pages | 8 |
Journal | Kidney international |
Volume | 83 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2013 |
Keywords
- Antibody-mediated rejection
- Diagnosis
- Kidney transplantation
ASJC Scopus subject areas
- Nephrology