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2021-11-12

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cc-by (c) Piñeiro GJ et al., 2021
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/225040

Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.

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https://doi.org/10.3389/fmed.2021.761919

Resum

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

Matèries

Trasplantament renal, Rebuig (Biologia), Inflamació

Matèries (anglès)

Kidney transplantation, Graft rejection, Inflammation

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Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

Citació

PIÑEIRO, Gastón julio, MONTAGUD MARRAHI, Enrique, RÍOS, José, VENTURA AGUIAR, Pedro, CUCCHIARI, David, REVUELTA, Ignacio, LOZANO, Miquel, CID VIDAL, Joan, COFÁN PUJOL, Frederico, ESFORZADO ARMENGOL, Nuria, PALOU RIBERA, Eduard, OPPENHEIMER SALINAS, Federico, CAMPISTOL PLANA, Josep m., BAYÉS GENÍS, Beatriu, ROVIRA JUÁREZ, Jordi, DIEKMANN, Fritz. Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.. _Frontiers in Medicine_. 2021. Vol. 8. [consulta: 25 de desembre de 2025]. ISSN: 2296-858X. [Disponible a: https://hdl.handle.net/2445/225040]

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