Renal Allograft Loss After Early Antibody-Mediated Rejection
Renal Allograft Loss After Early Antibody-Mediated Rejection
The development of AMR is associated with a significantly higher incidence of allograft loss, although the effects of AMR differ by transplant type. HLA-compatible live donor recipients who develop AMR do not have a higher risk of graft loss compared to their counterparts who do not develop AMR, and the risk for recipients of ABO-incompatible transplants remains inconclusive. However, deceased donor (both HLA-compatible and HLA-incompatible) and HLA-incompatible live donor recipients do have significantly higher risks of graft loss following AMR. The development of subclinical AMR is associated with a higher incidence of allograft loss compared to matched controls, though early treatment with plasmapheresis likely attenuates this risk. These findings highlight the need for strategies to prevent and aggressively treat subclinical AMR and strengthen the case for performing routine protocol biopsies in immunologically high-risk patients.
Conclusion
The development of AMR is associated with a significantly higher incidence of allograft loss, although the effects of AMR differ by transplant type. HLA-compatible live donor recipients who develop AMR do not have a higher risk of graft loss compared to their counterparts who do not develop AMR, and the risk for recipients of ABO-incompatible transplants remains inconclusive. However, deceased donor (both HLA-compatible and HLA-incompatible) and HLA-incompatible live donor recipients do have significantly higher risks of graft loss following AMR. The development of subclinical AMR is associated with a higher incidence of allograft loss compared to matched controls, though early treatment with plasmapheresis likely attenuates this risk. These findings highlight the need for strategies to prevent and aggressively treat subclinical AMR and strengthen the case for performing routine protocol biopsies in immunologically high-risk patients.
Source...