Department of Medicine, Hennepin County Medical Center, Hennepin Healthcare, Minneapolis, MN, USA.
Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Clin Transplant. 2021 Jul;35(7):e14337. doi: 10.1111/ctr.14337. Epub 2021 May 18.
Major gaps remain in our understanding of antibody-mediated rejection (AMR) after kidney transplant. We examined the incidence, risk factors, response to treatment, and effects on outcomes of AMR at seven transplant programs in the long-term Deterioration of Kidney Allograft Function prospective study cohort. Among 3131 kidney recipients, there were 194 observed AMR cases (6.2%) during (mean ± SD) 4.85 ± 1.86 years of follow-up. Time to AMR was 0.97 ± 1.17 (median, 0.48) years. Risk factors for AMR included younger recipient age, human leukocyte antigen DR mismatches, panel-reactive antibody >0%, positive T- or B-cell cross-match, and delayed graft function. Compared with no AMR, the adjusted time-dependent hazard ratio for death-censored graft failure is 10.1 (95% confidence interval, 6.5-15.7) for all AMR patients, 4.0 (2.5, 9.1) for early AMR (<90 days after transplant), and 24.0 (14.0-41.1) for late AMR (≥90 days after transplant). Patients were treated with different therapeutic combinations. Of 194 kidney transplant recipients with AMR, 50 (25.8%) did not respond to treatment, defined as second AMR within 100 days or no improvement in estimated glomerular filtration rate by 42 days. Long-term outcomes after AMR are poor, regardless of the initial response to treatment. Better prevention and new therapeutic strategies are needed to improve long-term allograft survival.
在肾移植后，我们对抗体介导的排斥反应（AMR）的理解仍存在很大差距。我们在长期的肾功能恶化前瞻性研究队列中，检查了 7 个移植项目中 AMR 的发生率、危险因素、对治疗的反应以及对结果的影响。在 3131 名肾移植受者中，在 4.85 ± 1.86 年的随访期间，观察到 194 例 AMR 病例（6.2%）。发生 AMR 的时间为 0.97 ± 1.17（中位数，0.48）年。AMR 的危险因素包括受者年龄较小、人类白细胞抗原 DR 错配、Panel-reactive antibody >0%、T 细胞或 B 细胞交叉配型阳性和延迟移植物功能。与无 AMR 相比，所有 AMR 患者死亡风险校正的时依风险比为 10.1（95%置信区间，6.5-15.7），早期 AMR（移植后<90 天）为 4.0（2.5, 9.1），晚期 AMR（移植后≥90 天）为 24.0（14.0-41.1）。患者接受了不同的治疗组合。在 194 例 AMR 肾移植受者中，50 例（25.8%）对治疗无反应，定义为 100 天内第二次发生 AMR 或 42 天内估计肾小球滤过率无改善。无论初始治疗反应如何，AMR 后的长期结局都很差。需要更好的预防和新的治疗策略来提高长期移植物存活率。
