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Kidney Week

Abstract: PO2578

Risk Factors and Outcomes of Acute and Refractory Antibody-Mediated Rejection

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Hart, Allyson, Hennepin Healthcare, Minneaplis, Minnesota, United States
  • Schladt, David P., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Itzler, Robbin F., CSL Behring, King of Prussia, Pennsylvania, United States
  • Israni, Ajay K., Hennepin Healthcare, Minneaplis, Minnesota, United States
  • Kasiske, Bertram L., Chronic Disease Research Group, Minneapolis, Minnesota, United States

Major gaps remain in our understanding of antibody-mediated rejection (AMR) after kidney transplantation. We examined incidence, risk factors, response to treatment, and effects on outcomes of locally-managed AMR at 7 transplant programs in the Long-Term Deterioration of Kidney Allograft Function (DeKAF) prospective study cohort.


Consecutive kidney or kidney-pancreas transplant recipients were enrolled in the DeKAF study from October 2005 through April 15, 2011. To determine the effect of AMR on death censored graft failure (DCGF), we performed Cox proportional hazards analyses including AMR as a time-dependent covariate.


Among 3131 kidney and kidney-pancreas recipients, there were 194 with a first AMR episode during a mean 4.85±1.86 years of follow-up for the entire cohort. Mean time to first AMR was 0.97 ±1.17 years post-transplant. After adjusting for other risk factors, patients with AMR had 10 times the risk of DCGF compared to patients with no AMR (aHR 10.1, 95% CI 6.5-15.7). Among the 50 (25.8%) patients whose AMR was refractory to treatment, defined as 2nd AMR diagnosis within 100 days or no improvement in eGFR by 42 days, the HR for DCGF was 7.5 (2.2-25.6, P=0.0013) in the first 180 days post biopsy; 3.8 (1.4-9.8, P=0.007) in the 1st year post biopsy, and 1.6 (0.9-3.0, P=0.11) at any time during follow-up compared to patients whose AMR responded to treatment.


Patients with AMR had substantially greater risk of DCGF compared to patients without AMR. While patients with refractory AMR were more likely to lose their graft compared to non-refractory cases in the first year following the AMR diagnosis, the likelihood of graft survival after that year was the same regardless of response to treatment.

Time to death-censored graft failures among recipients with refractory antibody-mediated rejection (N=50) and non-refractory antibody-mediated rejection (N=144)


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