Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation
Background: Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce.Methods: Retrospective study with kidney recipients diagnosed an active...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:13252032f1474e2ab0e46b1ac2e75cc72021-11-12T05:25:36ZInfluence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation2296-858X10.3389/fmed.2021.761919https://doaj.org/article/13252032f1474e2ab0e46b1ac2e75cc72021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.761919/fullhttps://doaj.org/toc/2296-858XBackground: Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce.Methods: Retrospective study with kidney recipients diagnosed an active ABMR from January 1, 2004 to December 31, 2019 to explore the influence of persistent inflammation in follow-up biopsies on graft survival after ABMR treatment.Results: About 116 patients were included. Active ABMR were treated with a combination of plasma exchange (PE), intravenous immunoglobulin (IVIg), rituximab, and steroids. At 6 months of treatment, 63 (54.3%) patients presented a stabilization or improvement in kidney-graft function. The effectiveness varied depending on the timepoint of the presentation between transplantation and rejection, which is lower for those with late ABMR (63 vs. 21% for early vs. late ABMR, respectively). Ninety patients (77%) underwent a control biopsy after ABMR treatment, from which 46 (51%) responded to the treatment. Microvascular inflammation (MVI) persisted in 64 (71%) biopsies, whereas tubulitis persisted in 17 (19%) biopsies. Death-censored graft survival at 1 year was significantly lower in patients with persistent MVI (86% vs. 95% without persistent MVI, P = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, P = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35–14.96), P = 0.01] and tubulitis [HR 2.88 95%CI (1.24–6.69), P = 0.01) in follow-up biopsies significantly increased the risk of graft failure.Conclusion: Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria.Study Registration: Agencia Española de Medicamentos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTRINM-2017-01.Gaston J. PiñeiroGaston J. PiñeiroEnrique Montagud-MarrahiEnrique Montagud-MarrahiJosé RíosPedro Ventura-AguiarPedro Ventura-AguiarDavid CucchiariDavid CucchiariIgnacio RevueltaIgnacio RevueltaMiquel LozanoJoan CidFrederic CofanNuria EsforzadoEduard PalouFederico OppenheimerFederico OppenheimerJosep M. CampistolJosep M. CampistolJosep M. CampistolBeatriu Bayés-GenísBeatriu Bayés-GenísJordi RoviraJordi RoviraFritz DiekmannFritz DiekmannFritz DiekmannFrontiers Media S.A.articlekidney transplantationantibody-mediated rejectiongraft failurefollow-up biopsymicrovascular inflammationMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021) |
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kidney transplantation antibody-mediated rejection graft failure follow-up biopsy microvascular inflammation Medicine (General) R5-920 |
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kidney transplantation antibody-mediated rejection graft failure follow-up biopsy microvascular inflammation Medicine (General) R5-920 Gaston J. Piñeiro Gaston J. Piñeiro Enrique Montagud-Marrahi Enrique Montagud-Marrahi José Ríos Pedro Ventura-Aguiar Pedro Ventura-Aguiar David Cucchiari David Cucchiari Ignacio Revuelta Ignacio Revuelta Miquel Lozano Joan Cid Frederic Cofan Nuria Esforzado Eduard Palou Federico Oppenheimer Federico Oppenheimer Josep M. Campistol Josep M. Campistol Josep M. Campistol Beatriu Bayés-Genís Beatriu Bayés-Genís Jordi Rovira Jordi Rovira Fritz Diekmann Fritz Diekmann Fritz Diekmann Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation |
| description |
Background: Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce.Methods: Retrospective study with kidney recipients diagnosed an active ABMR from January 1, 2004 to December 31, 2019 to explore the influence of persistent inflammation in follow-up biopsies on graft survival after ABMR treatment.Results: About 116 patients were included. Active ABMR were treated with a combination of plasma exchange (PE), intravenous immunoglobulin (IVIg), rituximab, and steroids. At 6 months of treatment, 63 (54.3%) patients presented a stabilization or improvement in kidney-graft function. The effectiveness varied depending on the timepoint of the presentation between transplantation and rejection, which is lower for those with late ABMR (63 vs. 21% for early vs. late ABMR, respectively). Ninety patients (77%) underwent a control biopsy after ABMR treatment, from which 46 (51%) responded to the treatment. Microvascular inflammation (MVI) persisted in 64 (71%) biopsies, whereas tubulitis persisted in 17 (19%) biopsies. Death-censored graft survival at 1 year was significantly lower in patients with persistent MVI (86% vs. 95% without persistent MVI, P = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, P = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35–14.96), P = 0.01] and tubulitis [HR 2.88 95%CI (1.24–6.69), P = 0.01) in follow-up biopsies significantly increased the risk of graft failure.Conclusion: Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria.Study Registration: Agencia Española de Medicamentos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTRINM-2017-01. |
| format |
article |
| author |
Gaston J. Piñeiro Gaston J. Piñeiro Enrique Montagud-Marrahi Enrique Montagud-Marrahi José Ríos Pedro Ventura-Aguiar Pedro Ventura-Aguiar David Cucchiari David Cucchiari Ignacio Revuelta Ignacio Revuelta Miquel Lozano Joan Cid Frederic Cofan Nuria Esforzado Eduard Palou Federico Oppenheimer Federico Oppenheimer Josep M. Campistol Josep M. Campistol Josep M. Campistol Beatriu Bayés-Genís Beatriu Bayés-Genís Jordi Rovira Jordi Rovira Fritz Diekmann Fritz Diekmann Fritz Diekmann |
| author_facet |
Gaston J. Piñeiro Gaston J. Piñeiro Enrique Montagud-Marrahi Enrique Montagud-Marrahi José Ríos Pedro Ventura-Aguiar Pedro Ventura-Aguiar David Cucchiari David Cucchiari Ignacio Revuelta Ignacio Revuelta Miquel Lozano Joan Cid Frederic Cofan Nuria Esforzado Eduard Palou Federico Oppenheimer Federico Oppenheimer Josep M. Campistol Josep M. Campistol Josep M. Campistol Beatriu Bayés-Genís Beatriu Bayés-Genís Jordi Rovira Jordi Rovira Fritz Diekmann Fritz Diekmann Fritz Diekmann |
| author_sort |
Gaston J. Piñeiro |
| title |
Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation |
| title_short |
Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation |
| title_full |
Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation |
| title_fullStr |
Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation |
| title_full_unstemmed |
Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation |
| title_sort |
influence of persistent inflammation in follow-up biopsies after antibody-mediated rejection in kidney transplantation |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/13252032f1474e2ab0e46b1ac2e75cc7 |
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