Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.

Background: Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce. Methods: Retrospective study with kidney recipients diagnosed an active...

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Authors: Piñeiro, Gastón Julio, Montagud Marrahi, Enrique, Ríos, José, Ventura Aguiar, Pedro, Cucchiari, David, Revuelta, Ignacio, Lozano, Miquel, Cid Vidal, Joan, Cofán Pujol, Frederico, Esforzado Armengol, Nuria, Palou Ribera, Eduard, Oppenheimer Salinas, Federico, Campistol Plana, Josep M., Bayés Genís, Beatriu, Rovira Juárez, Jordi, Diekmann, Fritz
Format: article
Status:Published version
Publication Date:2021
Country:España
Institution:Universidad de Barcelona
Repository:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/225040
Online Access:https://hdl.handle.net/2445/225040
Access Level:Open access
Keyword:Trasplantament renal
Rebuig (Biologia)
Inflamació
Kidney transplantation
Graft rejection
Inflammation
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spelling Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.Piñeiro, Gastón JulioMontagud Marrahi, EnriqueRíos, JoséVentura Aguiar, PedroCucchiari, DavidRevuelta, IgnacioLozano, MiquelCid Vidal, JoanCofán Pujol, FredericoEsforzado Armengol, NuriaPalou Ribera, EduardOppenheimer Salinas, FedericoCampistol Plana, Josep M.Bayés Genís, BeatriuRovira Juárez, JordiDiekmann, FritzTrasplantament renalRebuig (Biologia)InflamacióKidney transplantationGraft rejectionInflammationBackground: Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce. Methods: Retrospective study with kidney recipients diagnosed an active ABMR from January 1, 2004 to December 31, 2019 to explore the influence of persistent inflammation in follow-up biopsies on graft survival after ABMR treatment. Results: About 116 patients were included. Active ABMR were treated with a combination of plasma exchange (PE), intravenous immunoglobulin (IVIg), rituximab, and steroids. At 6 months of treatment, 63 (54.3%) patients presented a stabilization or improvement in kidney-graft function. The effectiveness varied depending on the timepoint of the presentation between transplantation and rejection, which is lower for those with late ABMR (63 vs. 21% for early vs. late ABMR, respectively). Ninety patients (77%) underwent a control biopsy after ABMR treatment, from which 46 (51%) responded to the treatment. Microvascular inflammation (MVI) persisted in 64 (71%) biopsies, whereas tubulitis persisted in 17 (19%) biopsies. Death-censored graft survival at 1 year was significantly lower in patients with persistent MVI (86% vs. 95% without persistent MVI, P = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, P = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35-14.96), P = 0.01] and tubulitis [HR 2.88 95%CI (1.24-6.69), P = 0.01) in follow-up biopsies significantly increased the risk of graft failure. Conclusion: Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria. Study Registration: Agencia Española de Medicamentos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTRINM-2017-01Frontiers Media2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/225040Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.3389/fmed.2021.761919Frontiers in Medicine, 2021, vol. 8https://doi.org/10.3389/fmed.2021.761919cc-by (c) Piñeiro et al., 2021http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2250402026-05-27T06:46:51Z
dc.title.none.fl_str_mv Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
title Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
spellingShingle Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
Piñeiro, Gastón Julio
Trasplantament renal
Rebuig (Biologia)
Inflamació
Kidney transplantation
Graft rejection
Inflammation
title_short Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
title_full Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
title_fullStr Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
title_full_unstemmed Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
title_sort Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation.
dc.creator.none.fl_str_mv Piñeiro, Gastón Julio
Montagud Marrahi, Enrique
Ríos, José
Ventura Aguiar, Pedro
Cucchiari, David
Revuelta, Ignacio
Lozano, Miquel
Cid Vidal, Joan
Cofán Pujol, Frederico
Esforzado Armengol, Nuria
Palou Ribera, Eduard
Oppenheimer Salinas, Federico
Campistol Plana, Josep M.
Bayés Genís, Beatriu
Rovira Juárez, Jordi
Diekmann, Fritz
author Piñeiro, Gastón Julio
author_facet Piñeiro, Gastón Julio
Montagud Marrahi, Enrique
Ríos, José
Ventura Aguiar, Pedro
Cucchiari, David
Revuelta, Ignacio
Lozano, Miquel
Cid Vidal, Joan
Cofán Pujol, Frederico
Esforzado Armengol, Nuria
Palou Ribera, Eduard
Oppenheimer Salinas, Federico
Campistol Plana, Josep M.
Bayés Genís, Beatriu
Rovira Juárez, Jordi
Diekmann, Fritz
author_role author
author2 Montagud Marrahi, Enrique
Ríos, José
Ventura Aguiar, Pedro
Cucchiari, David
Revuelta, Ignacio
Lozano, Miquel
Cid Vidal, Joan
Cofán Pujol, Frederico
Esforzado Armengol, Nuria
Palou Ribera, Eduard
Oppenheimer Salinas, Federico
Campistol Plana, Josep M.
Bayés Genís, Beatriu
Rovira Juárez, Jordi
Diekmann, Fritz
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Trasplantament renal
Rebuig (Biologia)
Inflamació
Kidney transplantation
Graft rejection
Inflammation
topic Trasplantament renal
Rebuig (Biologia)
Inflamació
Kidney transplantation
Graft rejection
Inflammation
description Background: Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce. Methods: Retrospective study with kidney recipients diagnosed an active ABMR from January 1, 2004 to December 31, 2019 to explore the influence of persistent inflammation in follow-up biopsies on graft survival after ABMR treatment. Results: About 116 patients were included. Active ABMR were treated with a combination of plasma exchange (PE), intravenous immunoglobulin (IVIg), rituximab, and steroids. At 6 months of treatment, 63 (54.3%) patients presented a stabilization or improvement in kidney-graft function. The effectiveness varied depending on the timepoint of the presentation between transplantation and rejection, which is lower for those with late ABMR (63 vs. 21% for early vs. late ABMR, respectively). Ninety patients (77%) underwent a control biopsy after ABMR treatment, from which 46 (51%) responded to the treatment. Microvascular inflammation (MVI) persisted in 64 (71%) biopsies, whereas tubulitis persisted in 17 (19%) biopsies. Death-censored graft survival at 1 year was significantly lower in patients with persistent MVI (86% vs. 95% without persistent MVI, P = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, P = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35-14.96), P = 0.01] and tubulitis [HR 2.88 95%CI (1.24-6.69), P = 0.01) in follow-up biopsies significantly increased the risk of graft failure. Conclusion: Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria. Study Registration: Agencia Española de Medicamentos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTRINM-2017-01
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/225040
url https://hdl.handle.net/2445/225040
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3389/fmed.2021.761919
Frontiers in Medicine, 2021, vol. 8
https://doi.org/10.3389/fmed.2021.761919
dc.rights.none.fl_str_mv cc-by (c) Piñeiro et al., 2021
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Piñeiro et al., 2021
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Frontiers Media
publisher.none.fl_str_mv Frontiers Media
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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