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Clinical significance of de novo donor-specific antibody in kidney transplant recipients with chronic antibody-mediated rejection

대한이식학회지 2021년 35권 1호 p.33 ~ 40
박우영, 김예림, 백진혁, 진규복, 한승엽,
소속 상세정보
박우영 ( Park Woo-Yeong ) - Keimyung University School of Medicine Department of Internal Medicine
김예림 ( Kim Yae-Rim ) - Keimyung University School of Medicine Department of Internal Medicine
백진혁 ( Paek Jin-Hyuk ) - Keimyung University School of Medicine Department of Internal Medicine
진규복 ( Jin Kyu-Bok ) - Keimyung University School of Medicine Department of Internal Medicine
한승엽 ( Han Seung-Yeup ) - Keimyung University School of Medicine Department of Internal Medicine

Abstract


Background: Chronic antibody-mediated rejection (CABMR) is an important cause of late graft loss. De novo donor-specific antibody (dnDSA) is an important prognostic factor for long-term allograft outcomes. However, the prognosis of CABMR based on the presence of dnDSA is uncertain.

Methods: We retrospectively analyzed 35 kidney transplant recipients with CABMR between 2010 and 2018. Fourteen recipients had no detectable DSA, and 21 recipients had detectable DSA. We investigated the pathologic findings at diagnosis of CABMR, allograft function 12 months later, related factors for allograft failure, and allograft survival rate based on the presence of dnDSA.

Results: The pathologic findings showed that acute and chronic changes were more severe in the dnDSA (+) group than in the dnDSA (?) group. There was no significant difference in the allograft function 12 months after the diagnosis of CABMR and in the amount of proteinuria at diagnosis between the two groups. However, the death-censored graft survival rate was lower in the high-proteinuria group than in the low-proteinuria group in both groups. The treatment rate of recipients was higher in the dnDSA (+) group than in the dnDSA (?) group; however, there was no significant difference in the death-censored graft survival rate between the two groups.

Conclusions: Although the effect of dnDSA on the prognosis of CABMR is not clear, it would be important not to neglect treatment for CABMR with risk factors for allograft failure even without dnDSA. Continuous and rigorous surveillance of DSA and allograft function is needed in patients with CABMR.

키워드

Kidney transplantation; Graft rejection; Antibodies; Risk factor; Treatment

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