INTRODUCTION

Antibody mediated rejection (ABMR) is recognised as one of the biggest challenges in renal transplant.(1) It is one of the major determinants of graft survival.(2)ABMR is distinct from T cell mediated rejection (TCMR) but shares inflammation elements with TCMR.

AIM OF STUDY 

1. To study the clinical profile of renal transplant recipients with antibody mediated rejection ABMR alone and combined ABMR and TCMR.

2. Toassess and compare the outcomes in these patients.

METHODOLOGY

This is a retrospective observational study. The data of a total of 18 renal transplant recipients who had biopsy proven ABMR(either alone or with combined TCMR) were included in this study. They were divided into 2 groups. Group 1 – recipients with ABMR alone and Group 2 – recipients with combined ABMR and TCMR. They were studied for their clinical profile. Their outcomes were assessed in terms of doubling of serum creatinine, graft loss, all infections, death from all causes and these were compared between the two group

RESULTS

Group 1 had a total of 6 recipients and group 2 had 11 recipients. Baseline characteristics and outcomes were comparable between the two groups. There was no significant difference between both the groups in terms of age, gender, donor type. Anti thymocyte globulin(ATG) was given as an induction agent for 2 patients in group 1 and 6 patients in group 2. In both the groups, the time of ABMR was mostly more than 6 months post transplant. The mean creatinine at the time of rejection was 2.14+/-0.34 mg/dl in group 1 and 3.34+/-1.45 mg/dl in group2. Infections such as bacterial and Cytomegalovirus, were seen more in group 2. Doubling of serum creatinine was seen in 2 patients (33.3%) in group 1 and 5 patients (45.4%) in group 2. 1 patient (16.6%) in group1 and 3 patients (27.2%) in group 2 had graft loss. Death (all cause) was seen in 2 patients(18.1%) in group 2 and none in group 1.

CONCLUSION

The group with combined antibody and cell mediated rejection had a increased risk of doubling of serum creatinine and graft loss. Infectious complications were more in group 2. ABMR is an important barrier in terms of graft survival.(3) The evidence for efficacy of treatment for ABMR is unsatisfactory.

REFERENCES 

1. Sellarés J, de Freitas DG, Mengel M, et al.. Understanding the causes of kidney transplant failure: the dominantrole of antibody -mediated rejection and nonadherence. Am J Transplant 2012; 12:388–399.
2. Balasubramanian Karthikeyan, Raj K. Sharma,Sonia Mehrotra, Amit Gupta, Anupama Kaul,Dharmendra S.Bhaudauria, andNarayan Prasad – Comparative Analysis of Determinants and Outcome of Early and Late Acute Antibody Mediated Rejection (ABMR)Indian J Nephrol. 2023 Jan-Feb; 33: 22–27
3. Vural Taner Yilmaza, Ozgur Dandinb, Abdullah Kisaoglub, Ali Avanazb, Davut Kamacic, Havva SerapTorud, Ismail Demiryilmazb, Sadi Koksoye, Bulent Aydinlib, and Huseyin Kocaka – Prognosis andTreatment for Active and Chronic Antibody-Mediated Rejection in Renal Transplant Recipients; Single Center Experience- Transplantation Proceedings, 54, 1809−1815 (2022)

Authors

Dr Yashilha D
Nephrology PG Resident
Kauvery Hospital, Chennai

Dr R Balasubramaniyam
Chief Nephrologist
Kauvery Hospital, Chennai

Dr B Balaji Kirushnan
Nephrologist
Kauvery Hospital, Chennai