Clinicopathologic Characteristics and Outcomes of Late Acute Antibody-Mediated Rejection in Thai Kidney Transplant Recipients: A Single-Center Experience

Larpparisuth, Nuttasith; Premasathian, Nalinee; Vareesangthip, K.; Cheunsuchon, Boonyarit; Parichatikanon, P.; Vongwiwatana, Attapong

doi:10.1016/j.transproceed.2014.01.003

Cited by 4 publications

(25 citation statements)

References 11 publications

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“…We speculated that patients with negative donor-specific antibody have this because of adsorption in the graft or non-HLA specificities. 26,29 In our study, the rate of C4d positivity was 7 (4%) in all patients having AAMR and the combination of AAMR and ATCMR. Ten patients (5.7%) were C4d negative in which morphologic findings of AAMR were observed.…”

Section: Discussionmentioning

confidence: 44%

Untitled

Canpolat

Özdemir²,

Torun³

et al. 2017

Exp Clin Transplant

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Objectives: Kidney transplant is the best treatment for patients with end-stage renal disease. Long-term graft survival depends on the protection of renal allograft function. Renal allograft biopsy is the most important method for examining an allograft function. Biopsy provides critical information, enabling diagnosis and grading of pathologic changes, prediction of response to therapy, and long-term graft prognosis.

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Section: Discussionmentioning

confidence: 44%

Untitled

Canpolat

Özdemir²,

Torun³

et al. 2017

Exp Clin Transplant

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“…The mean number of Tac trough levels obtained to calculate IPV [6][7][8][9][10][11][12] and IPV 6-24 was 5.0 6 1.1 and 11.2 6 2.47, respectively. IPV [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] was significantly higher than IPV [6][7][8][9][10][11][12] (P , 0.001); however, IPV [6][7][8][9][10][11][12] was comparable to IPV [13][14][15][16][17][18][19][20][21][22][23]…”

Section: Resultsmentioning

confidence: 87%

“…Kaplan-Meier survival analysis revealed a significantly higher cumulative incidence of DSA development and/or late rejection among patients with high IPV (IPV [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] .23.5%) compared with those with low IPV (IPV 6-24 #23.5%; P = 0.048; Fig. 1).…”

Section: Resultsmentioning

confidence: 94%

“…Patients with DSA and/or late rejection showed significantly higher mean IPV [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] than those without (29.42% 6 13.78% versus 22.77% 6 9.65%; P = 0.002). However, mean IPV [6][7][8][9][10][11][12] was not significantly different between patients with and without DSA and/or late rejection (24.31% 6 14.98% versus 20.17% 6 10.90%; P = 0.17).…”

Section: Resultsmentioning

confidence: 95%

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High Intrapatient Variability in Tacrolimus Exposure Calculated Over a Long Period Is Associated With De Novo Donor-Specific Antibody Development and/or Late Rejection in Thai Kidney Transplant Patients Receiving Concomitant CYP3A4/5 Inhibitors

Larpparisuth

Pongnatcha

Panprom

et al. 2021

Therapeutic Drug Monitoring

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Background: High intrapatient variability in tacrolimus trough levels (Tac IPV) is associated with poor allograft outcomes. Tac IPV was previously calculated using trough levels 6-12 months after kidney transplantation (KT). Data on the accuracy of Tac IPV calculation over a longer period, the association between high Tac IPV and donor-specific antibody (DSA) development after KT in Asian patients, and the role of IPV in patients receiving concomitant cytochrome P450 (CYP)3A4/5 inhibitors (CYPinh) are limited.Methods: A retrospective review of patients who underwent KT at our center in 2005-2015, and who received Tac with mycophenolate during the first 2 years after KT was performed. IPV was calculated using Tac levels adjusted by dosage. DSA was monitored annually after KT using a Luminex microbead assay.Results: In total, 236 patients were enrolled. CYPinh were prescribed to 189 patients (80.1%): 145 (61.4%), 31 (13.1%), and 13 (5.5%) received diltiazem, fluconazole, and ketoconazole, respectively. Mean IPV calculated from adjusted Tac levels for 6-12 months (IPV [6][7][8][9][10][11][12] ) and 6-24 months (IPV 6-24 ) after KT were 20.64% 6 11.68% and 23.53% 6 10.39%, respectively. Twentysix patients (11%) showed late rejection and/or DSA occurrence, and had significantly higher IPV 6-24 (29.42% 6 13.78%) than others (22.77% 6 9.64%; P = 0.02). There was no difference in IPV [6][7][8][9][10][11][12] (24.31% 6 14.98% versus 20.17% 6 10.90%; P = 0.18). IPV [6][7][8][9][10][11][12] and IPV [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] were comparable in patients who did and did not receive CYPinh. When using mean IPV 6-24 as a cutoff, patients with higher IPV 6-24 had a higher probability of developing DSA and/or late rejection (P = 0.048).Conclusions: Tac IPV 6-24 was higher and more significantly associated with DSA development and/or late rejection than Tac IPV 6-12 , independent of Tac trough level. This is the first study to demonstrate the impact of high IPV on DSA development in Asian patients, and that Tac IPV is comparable between patients with and without CYPinh.

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“…[ 18 ] In a recent publication by Larpparisuth et al ., it was shown that DSA was detected in 25 of the 34 patients with Late Acute ABMR. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Expanding the antibody-mediated component of plasma cell-rich acute rejection: A case series

Ms¹,

Swarnalatha²,

Taduri³

et al. 2016

Indian J Nephrol

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Renal allograft rejection is mediated by T-cells (T-cell mediated rejection) or by donor-specific antibodies (DSAs) (antibody mediated rejection, ABMR). Plasma cell-rich acute rejection (PCAR) is a unique entity due to its peculiar morphology and poor prognostic behavior. All allograft biopsies done at our center from January 2013 to October 2014 were reviewed, and seven were identified with a diagnosis of PCAR with antibody mediated rejection (ABMR). The allograft biopsies were classified as per the Banff 2007 schema. Immunohistochemistry with C4d, SV 40, CD3, CD20, CD138, kappa and lambda light chain was performed. Total 210 allograft biopsies were performed in the study period of which seven biopsies (3.3%) were diagnosed as PCAR with ABMR. All these were late ABMRs (more than 6 months) with median posttransplant duration of 17 months. The allograft biopsy showed features of PCAR along with glomerulitis, peritubular capillaritis, and positive C4d. DSA was positive in six patients. All the patients were treated with standard therapeutic measures of acute cellular rejection (ACR) and ABMR including steroids, plasma exchange, rituximab and intravenous immunoglobulins. All the patients had persistent graft dysfunction or graft loss on follow-up.

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Clinicopathologic Characteristics and Outcomes of Late Acute Antibody-Mediated Rejection in Thai Kidney Transplant Recipients: A Single-Center Experience

Cited by 4 publications

References 11 publications

Untitled

Untitled

High Intrapatient Variability in Tacrolimus Exposure Calculated Over a Long Period Is Associated With De Novo Donor-Specific Antibody Development and/or Late Rejection in Thai Kidney Transplant Patients Receiving Concomitant CYP3A4/5 Inhibitors

Expanding the antibody-mediated component of plasma cell-rich acute rejection: A case series

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