Intermediate Term Outcomes of Early and Late Acute Antibody-Mediated Rejection After Kidney Transplantation.

Purpose Acute antibody-mediated rejection (AAMR) has been recognized as a major cause of graft failure in kidney transplantation. The clinical course of early and late AAMR may differ. The aim of this study was to evaluate kidney graft survival of early versus late AAMR and to define clinical difference and risk factors for early and late AAMR. Methods Between January 2003 and April 2013, we performed 835 renal transplants into adult recipients. AAMR was diagnosed in 51 (6.1%) patients with median follow-up of 45.1 months (range 24 days-120 months). Recipients was divided into two groups: ‘early AAMR’ (< 3 months after transplantation), ‘late AAMR (> 3 months after transplantation) Results During a 10-year period, we identified 51 patients of AAMR, 36 (70.6%) early AAMR and 15 late AAMR. The median time to AAMR was 18 days (range, 5-84 days) in the early group and 30 months (range, 3-115 months) in the late group. In the early AAMR group, 25(69.4%) were female recipient (P=0.002). It showed an increased incidence of pregnancy (n=19, P= 0.188), blood transfusion (n=32, P<0.001), deceased donor type (n=18, P=0.045), retransplantation (n=11, P=0.177), High PRA (> 50%) (n=16, P=0.193), and DGF (n=8, P=0.048). But, the mean serum creatinine level at diagnosis, 7days, 1month, 6months and 1 year after treatment of AAMR was not significantly different between two groups (P= 0.553, 0.837, 0.891, 0.744, and 0.924, respectively). Graft survival at 1year, 3years, 5years post-transplantation were 88.9%, 84.8%, and 79.5%, respectively, in the early AAMR group compared to 100%, 88.9%, and 74.1%, respectively, in the late AAMR group. There were no significant differences in graft survival (P=0.722)[Figure 1] or patient survival (P=0.974) between the two groups. Conclusion Although early AAMR group showed high incidence of risk factors for AAMR, intermediate term graft and patient survival were compared to those of late AAMR group. Early diagnosis and aggressive treatment may resolve AAMR.