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Correlations between donor-specific antibodies and non-adherence with chronic active antibody-mediated rejection phenotypes and their impact on kidney graft survival
- Source :
- Human immunology. 79(6)
- Publication Year :
- 2018
-
Abstract
- Chronic-active antibody-mediated rejection (CAABMR) is associated with poor kidney graft survival and has no clear effective treatment. Forty-one cases of CAABMR were detected in indication graft biopsies and evaluated according to current Banff classification. We investigated the impact of concurrent donor-specific antibodies (DSA) and their characteristics, together with non-adherence regarding immunosuppression on CAABMR histopathological phenotypes and prognosis. Twenty-four (59%) patients had detectable DSA at biopsy, with 15 of them being considered non-adherent. Graft function at biopsy was similar in DSA (+) and (−) patients. DSA (+) patients had significantly higher tubulointerstitial inflammation (i and ti) and acute humoral (g+ptc+v+C4d) composite score than DSA (−). DSA (+)/non-adherent cases presented additionally with increased microvascular inflammation (ptc and v), besides having a distinctively lower ah score. C1q DSA strength was higher (P = .046) in non-adherent patients and correlated closely with C4d score (P = .002). Lower graft function and ah score, higher proteinuria and ci + ct score, and, separately per each model, DSA (+) (HR = 2.446, P = .034), DSA (+)/non-adherent (HR = 3.657, P = .005) and DSA (+)/C1q (+) (HR = 4.831, P = .003) status were independent predictors of graft failure. CAABMR with concomitant DSA pose a higher risk of graft failure. Adherence should be evaluated, and histopathological phenotyping and DSA characterization may add critical information.
- Subjects :
- Adult
Graft Rejection
Male
medicine.medical_specialty
medicine.medical_treatment
Immunology
030232 urology & nephrology
030230 surgery
Gastroenterology
Medication Adherence
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Isoantibodies
Internal medicine
Biopsy
medicine
Immunology and Allergy
Humans
Kidney
Proteinuria
biology
medicine.diagnostic_test
Chronic Active
business.industry
Complement C1q
Graft Survival
Immunosuppression
General Medicine
Middle Aged
Phenotype
Kidney Transplantation
Tissue Donors
Immunity, Humoral
body regions
medicine.anatomical_structure
Concomitant
Chronic Disease
biology.protein
Female
Antibody
medicine.symptom
business
Immunosuppressive Agents
Subjects
Details
- ISSN :
- 18791166
- Volume :
- 79
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Human immunology
- Accession number :
- edsair.doi.dedup.....1ee4c866948adeff59ad30b916244a81