scholarly journals Pure T-cell-mediated rejection following kidney transplant according to the response to treatment in the era of antibody-mediated rejection

2020 ◽  
Vol 34 (1) ◽  
pp. S15-S15
Author(s):  
Hyunwook Kwon ◽  
Sung Shin ◽  
Duck Jong Han ◽  
Young Hoon Kim ◽  
Joo Hee Jung ◽  
...  
Keyword(s):  
T Cell ◽  
Kidney Transplant ◽  
Response To Treatment ◽  
Antibody Mediated Rejection

scholarly journals P1756ANTI-ABO ANTIBODY- VERSUS ANTI-HLA ANTIBODY-INDUCED ANTIBODY MEDIATED REJECTION IN ABO-INCOMPATIBLE KIDNEY TRANSPLANT PATIENTS: RELATIVE INCIDENCE AND PHENOTYPE DIFFERENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jinmin Kong ◽  
Hyukyong Kwon ◽  
Sung Son ◽  
EUN Whang
Keyword(s):  
Kidney Transplant ◽  
Blood Group ◽  
Relative Frequency ◽  
Response To Treatment ◽  
Clinical Feature ◽  
Antibody Mediated Rejection ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Hla Antibody ◽  
Case Based

Abstract Background and Aims Antibody-mediated rejection(AMR) in ABO incompatible(ABOi) kidney transplant(KT) patients can either be due to donor-specific anti-HLA antibody(DSA) or anti-blood group antibody. The relative frequency and possible phenotype difference of these two types of AMR in ABOi KT patients have not been reported. Method Of 111 ABOi KT patients between 2007 and 2019 in our center, 15(13.5%) patients developed acute AMR diagnosed by indication biopsy. Since there is no histologic distinction between DSA- and anti-ABO-induced AMR, we assumed the causative antibody in each case based on anti-ABO level and DSA, measured in serum collected at the time of AMR. Results Of these 15 cases of acute AMR, 5 were attributable to anti-ABO(ABO-AMR) since anti-ABO titer was higher (≥16) and DSA was undetectable at the time of rejection. Five cases were attributable to DSA(DSA-AMR) since DSA was detectable and anti-ABO was lower during rejection. Another 3 cases with lower anti-ABO titer and undetectable DSA were also assumed to be DSA-induced, since this low level of anti-ABO is unlikely to cause rejection and DSA can be undetectable in DSA-induced AMR by adsorption of Ab on graft, as frequently seen in ABO-compatible patients Two cases with both higher anti-ABO titer and detectable DSA was regarded as undetermined. The onset of acute AMR was within 2 weeks in all cases(median 7.0 days) and comparable between DSA- and ABO-AMR. Initial anti-ABO titer was also not statistically different; median(range) 256(64-4096) in ABO-AMR and 64(16-256) in DSA-AMR. All the 5 patients with ABO-AMR had negative PRA before KT, whereas 5 of 8 patients with DSA-AMR had positive PRA before KT, and two DSA-AMR patients had preformed DSA before KT. There was no difference in peak creatinine and response to treatment. All the AMR were recovered by treatment and no graft was lost to rejection. No patient with ABO-AMR developed chronic AMR whereas one of DSA-AMR patients developed chronic AMR. Conclusion In summary, among 15 cases of acute AMR, 5 were ABO-AMR, 8 were DSA-AMR and 2 were undetermined. There was no difference in clinical feature between DSA- and ABO-AMR. No patient with ABO-AMR developed chronic AMR.

MO1001THE OUTCOME OF PLASMA CELL-RICH ACUTE REJECTION IN KIDNEY TRANSPLANTATION, IS IT REALLY POOR?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tarek S H Mahmoud ◽  
Osama Gheith ◽  
Jude Yagan ◽  
Ahmad Al-Taleb ◽  
Medhat MA Halim ◽  
...  
Keyword(s):  
T Cell ◽  
Acute Rejection ◽  
Kidney Transplant ◽  
Plasma Cell ◽  
Membranous Nephropathy ◽  
Post Treatment ◽  
Hla Typing ◽  
Antibody Mediated Rejection ◽  
Banff Classification ◽  
Associated Conditions

Abstract Background and Aims The outcome of Plasma cell-rich acute rejection (PCAR) in kidney transplant is reported to be poor. However, PCAR which can be associated with any type of rejection, may not be considered as independent morphological prognostic feature. Different treatment modalities were prescribed with variable responses. We report here four cases of PCAR and describe their presentations, type of rejection, associated conditions and treatment outcome. Method Out of 1920 kidney transplant recipients under follow up in our centre from 1996 till 2019, four patients were reported to have PCAR according to 2007 Banff classification. They were re-evaluated based on 2015 Banff classification. The treatment protocol was tailored according to the type of rejection and associated conditions. Results The four patients, aged 28, 44, 46 and 54 years, had live unrelated renal transplant done somewhere abroad with no data about donor HLA typing. Two of them were females. One had high PRA and she was positive for HBsAg. One patient received induction immunosuppression with basiliximab. They all received prednisolone, mycophenolate and cyclosporine as the maintenance immunosuppression and had immediate graft function. Rejection happened between 23 to 180 months post-transplant. Two patients had acute T-cell mediated Banff 1A rejections with features consistent with early membranous nephropathy. One had acute T-cell mediated rejection Banff 1B and the fourth had borderline T-cell mediated rejection with morphological changes suggestive of chronic active antibody mediated rejection (AMR). Plasma cells constituted 10 to 30% of the interstitial infiltration. All patients received solumedrol pulse. Both patients with features of membranous nephropathy received rituximab and one of them had additionally IVIG. The patient with AMR received plasma exchange and IVIG. However, she did not receive rituximab as she was positive for HBsAg. All patients responded well to treatment and the mean improvement in eGFR was 12.8%, 24.9%, 40.3% and 39.1% at 1-, 3-, 6- and 12-months post treatment. Repeat kidney biopsy at 3 to 12 weeks post treatment showed resolution of plasma cell infiltration in all patients. Conclusion Outcome of PCAR management was favourable among our patients irrespective of the type of rejection and associated conditions.

scholarly journals Antibody-mediated rejection, T cell–mediated rejection, and the injury-repair response: new insights from the Genome Canada studies of kidney transplant biopsies

2014 ◽  
Vol 85 (2) ◽  
pp. 258-264 ◽  
Author(s):  
Philip F. Halloran ◽  
Jeff P. Reeve ◽  
Andre B. Pereira ◽  
Luis G. Hidalgo ◽  
Konrad S. Famulski
Keyword(s):  
T Cell ◽  
Kidney Transplant ◽  
Injury Repair ◽  
Antibody Mediated Rejection

scholarly journals Pure T-cell mediated rejection following kidney transplant according to response to treatment

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256898
Author(s):  
Hyunwook Kwon ◽  
Young Hoon Kim ◽  
Youngmin Ko ◽  
Seong Jun Lim ◽  
Joo Hee Jung ◽  
...  
Keyword(s):  
T Cell ◽  
Graft Failure ◽  
Significant Risk ◽  
Diagnostic System ◽  
Significant Risk Factor ◽  
Response To Treatment ◽  
Histologic Diagnosis ◽  
Antibody Mediated Rejection ◽  
Long Time ◽  
The Impact

The focus of studies on kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on graft survival (GS) according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system on a separate group of 23 patients. A total of 63 patients were divided into non-responders (N = 22) and responders (N = 44). Non-response to rejection treatment was significantly associated with the following factors: glomerular filtration rate (GFR) at biopsy, ΔGFR, TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (OR = 3.31; P = 0.036) and lower GFR at biopsy (OR = 0.56; P = 0.026) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P = 0.004). Molecular assessment showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment.

Response to treatment in kidney transplant recipients with acute antibody-mediated rejection: A follow-up biopsy study

2020 ◽  
Vol 93 (2) ◽  
pp. 85-90
Author(s):  
Funda Taslı Alkan ◽  
Erhan Tatar ◽  
Murat Karatas ◽  
Cenk Simsek ◽  
Ismail Can Tercan ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Response To Treatment ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Antibody Mediated Rejection

scholarly journals Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment 

2020 ◽  
Author(s):  
Hyunwook Kwon ◽  
Young Hoon Kim ◽  
Dong Hyun Kim ◽  
Youngmin Ko ◽  
Seong Jun Lim ◽  
...  
Keyword(s):  
T Cell ◽  
Molecular Diagnosis ◽  
Graft Failure ◽  
Significant Risk ◽  
Response To Treatment ◽  
Histologic Diagnosis ◽  
Antibody Mediated Rejection ◽  
Molecular Assessment ◽  
One Year ◽  
The Impact

Abstract Over the last two decades, the focus of studies on graft survival (GS) after kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on GS according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system (MMDx) to determine the accuracy of the histologic diagnosis of pure TCMR. A total of 63 patients were included in our study and divided into non-responders (N = 22) and responders (N = 44) according to their response to rejection treatment. Molecular diagnosis and histologic diagnosis were conducted simultaneously on a separate group of 23 patients. The non-responders had a significantly longer duration between treatment and recurrent rejection than did the responders (24 vs. 11 months; P < 0.01). The cumulative incidence of recurrent rejection after treatment was significantly higher in the non-responders as well (64% vs. 29%; P < 0.01). Non-response to rejection treatment was significantly associated with the following factors: GFR at biopsy, ΔGFR (baseline GFR – GFR at biopsy), TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (HR = 3.31; P = 0.04) and lower GFR at biopsy per 10 mL/min/1.73m2 (HR = 0.56; P = 0.03) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P < 0.01). Molecular assessment using MMDx showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment. Molecular assessment using MMDx did not show a good correlation with histologic diagnosis in TCMR, suggesting that acute pure TCMR at one year after transplant in histologic reports should be interpreted with caution.

scholarly journals Disappearance of T Cell-Mediated Rejection Despite Continued Antibody-Mediated Rejection in Late Kidney Transplant Recipients

2014 ◽  
Vol 26 (7) ◽  
pp. 1711-1720 ◽  
Author(s):  
Philip F. Halloran ◽  
Jessica Chang ◽  
Konrad Famulski ◽  
Luis G. Hidalgo ◽  
Israel D.R. Salazar ◽  
...  
Keyword(s):  
T Cell ◽  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Antibody Mediated Rejection

SAT-440-Molecular fingerprint of T cell-mediated and antibody-mediated rejection after human liver transplantation

2019 ◽  
Vol 70 (1) ◽  
pp. e830
Author(s):  
Anne Höfer ◽  
Danny Jonigk ◽  
Björn Hartleben ◽  
Robert Geffers ◽  
Murielle Verboom ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
T Cell ◽  
Human Liver ◽  
Molecular Fingerprint ◽  
Antibody Mediated Rejection
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