Subclinical Antibody Mediated Rejection after Kidney Transplantation: Treatment Outcomes

Background Antibody-mediated rejection (ABMR) is a leading cause of morbidity and mortality after kidney transplantation. Early diagnosis and treatment of subclinical ABMR based on the donor-specific antibody (DSA) testing may result in better outcomes. Methods We tested this hypothesis in 220 kidney transplant recipients who underwent an indication or DSA-based surveillance protocol biopsies between 03/01/2013 and 12/31/2016. Patients were divided into three groups: clinical ABMR (n=118), subclinical ABMR (n=25), or no rejection on protocol biopsy (controls) (n=77). Results Both clinical and subclinical ABMR groups underwent similar treatment including plasmapheresis, pulse steroids, IVIG, and rituximab (p=ns). Mean follow-up after ABMR was 29.5 ± 16.8 months. There were 2 (3%), 2 (8%), and 54 (46%) death-censored graft failures in the control, subclinical, and clinical ABMR groups, respectively (p

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