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Abstract: FR-PO828

Treatment Outcome of Patients With Chronic Active Antibody-Mediated Rejection After Kidney Transplantation: Follow-Up Report of a Single Center Retrospective Study

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Chiu, Hsien-Fu, Taichung Veterans General Hospital, Taichung, Taiwan
  • Chen, Cheng-Hsu, Taichung Veterans General Hospital, Taichung, Taiwan
Background

Chronic active antibody-mediated rejection is a major etiology of graft loss in renal transplant recipients. Previously, we had reported that aggressive treatment was associated with better graft outcome at a median follow up duration of 32.5 months after the diagnosis of CAMR. Since chronic antibody mediated rejection is a chronic disease, this study aimed to prolong the follow up duration for 3 more years.

Methods

Adult kidney transplant recipients in Taichung Veterans General Hospital with CAMR were divided into two groups : Group 1 received aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2 received supportive treatment.

Results

After 3 more years of follow up, 1 more patient in supportive treatment group and 15 more patients in aggressive treatment group lost their allograft. Median graft survival was 8.4 and 4.3 years for aggressive treatment group and supportive treatment group, respectively. 27/59 (45.76%) patients in aggressive treatment group and 12/23 ( 52.17%) patients in supportive treatment group lost their allograft. Kaplan-Meier analysis of death-censored graft survival showed no significant difference between these two groups (p=0.263 by log-rank test).

Conclusion

Aggressive treatment is associated with better graft outcome in short term. However, there is still high risk of graft failure despite aggressive treatment in the long run. Risk and benefit of aggressive treatment should be evaluated before clinical decision.

Kaplan-Meier analysis of death-censored graft survival showed no significant difference between aggressive treatment and supportive treatment group (p=0.263 by log-rank test)