17 November 2020: Original Paper
Treatment of Antibody-Mediated Rejection After Kidney Transplantation: Immunological Effects, Clinical Response, and Histological Findings
Marcos Vinicius de Sousa 1ABCDEF* , Ana Claudia Gonçalez 2CD , Ricardo de Lima Zollner 3DE , Marilda Mazzali 1ADEDOI: 10.12659/AOT.925488
Ann Transplant 2020; 25:e925488
Table 2 Immunopathology and kidney function at diagnosis of antibody-mediated rejection (AMR) and after treatment.
| At AMR | 6 months after treatment | p* | 12 months after treatment | p** | |
|---|---|---|---|---|---|
| Patients with functioning graft, n (%) | 42 (100.0) | 37 (88.1) | 35 (83.3) | ||
| Class I PRA (%) | 41.8±33.3 | 21.1±21.7 | # | 16.8±17.6 | # |
| Class II PRA (%) | 54.7±34.7 | 58.7±28.3 | 0.63# | 51.8±32.5 | 0.75# |
| DSA, n (%) | 42 (100.0) | 21 (56.7) | 18 (51.4) | ||
| Only class I DSA | 11 (26.2) | 2 (9.5) | 0.28## | 3 (16.7) | 0.24## |
| Only class II DSA | 18 (42.8) | 12 (57.1) | 0.76## | 9 (50.0) | 0.35## |
| Class I and II DSA | 13 (31.0) | 7 (33.4) | 6 (33.3) | ||
| DSA | 20,427±16,329 | 23,558±15,170 | 0.46# | 21,217±14,874 | 0.86# |
| Class I DSA | 4,074±5,257 | 2,453±3,524 | 0.19# | 2,009±2,249 | 0.13# |
| DSA A | 7,198±4,982 | 4,537±3,621 | 0.12# | 2,988±4,118 | 0.03# |
| DSA B | 5,254±2,761 | 1,401±1,742 | 0.04# | 1,124±1,590 | 0.07# |
| Class II DSA | 16,248±15,612 | 19,780±15,260 | 0.39# | 18,975±15,455 | 0.54# |
| DSA DR | 2,778±947 | 0±0 | # | 0.0±0.0 | # |
| DSA DQ | 23,520±13,597 | 23,386±13,471 | 0.97# | 21,2878±14,658 | 0.60# |
| Immunodominant DSA | 13,588 (945.0–24,883) | 19,662 (1,400–24,647) | 0.29@ | 14,968 (1,400–22,859) | 0.74@ |
| Class I Non-DSA@@ | 7.4±8.4 | 3.6±4.2 | 0.04# | 1.8±2.1 | # |
| Class II Non-DSA@@ | 2.7±2.4 | 2.3±2.2 | 0.55# | 2.0±1.9 | 0.27 |
| SCr, mg/dL | 3.1±1.9 | 2.8±1.3 | 0.90# | 2.9±1.5 | 0.93# |
| eGFR (CKD-EPI), mL/min | 30.3±17.8 | 32.8±18.3 | 0.59# | 31.9±20.0 | 0.75# |
| UPC, g/g | 2.1±3.1 | 1.4±1.9 | 0.35# | 1.0±0.9 | 0.15# |
| UPC < 0.15 g/g | 6 (14.3) | 7 (18.9) | 0.99## | 7 (20.0) | 0.99## |
| Urinalysis, n (%) | |||||
| Red cells | 2 (4.8) | 0 (0.0) | 0 (0.0) | ||
| Leukocytes | 13 (30.9) | 4 (9.5) | 0.20## | 4 (9.5) | 0.20## |
| Protein | 23 (54.8) | 18 (42.8) | 0.88## | 14 (33.3) | 0.42## |
| Tacrolimus blood level (ng/mL) | 5.3±3.1 | 5.7±1.8 | 0.49# | 5.6±1.9 | 0.62# |
| AMR – acute mediated rejection; PRA – panel reactive antibody; DSA – donor specific antibody; SCr – serum creatinine; eGFR – estimated glomerular filtration rate; CKD-EPI, UPC – urine protein-to-creatinine ratio. * Compared to that presented at AMR; ** compared to that presented at AMR; # unpaired t-test; ## Chi-square test; @ Mann-Whitney test; @@ number of Non-DSA with mean fluorescence intensity higher than 1,500. | |||||