期刊
KIDNEY INTERNATIONAL
卷 83, 期 6, 页码 1185-1192出版社
ELSEVIER SCIENCE INC
DOI: 10.1038/ki.2013.44
关键词
antibody-mediated rejection; diagnosis; kidney transplantation
资金
- National Institutes of Health [NIDDK-DK067981-5]
- NIDDK [R01 DK092454-01]
- Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources (NCRR)
- National Institutes of Health (NIH)
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 (MFImax). 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 MFImax ranged from 10.3-57.2% and 262-1691, respectively, between low-and high-risk protocols. Mean MFImax 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 MFImax 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.
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