Reducing Donor Specific Antibody During Acute Rejection Diminishes Long Term Renal Allograft Loss: Comparison of Early and Late Rejection

BACKGROUND: Reduction in donor specific antibody (DSA) has been associated with improved renal allograft survival after antibody-mediated rejection (AMR). These observations have not been separately analyzed for early and late AMR and mixed acute rejection (MAR). The purpose of this study was to evaluate long term responses to proteasome inhibitor based (PI-based therapy) for 4 rejection phenotypes and to determine factors that predict allograft survival. METHODS: Retrospective cohort study evaluating renal transplant recipients with first AMR episodes treated with PI-based therapy from 01/2005 to 07/2015. RESULTS: A total of 108 patients were included in the analysis. Immunodominant DSA (iDSA) reduction at 14 days differed significantly (early AMR 79.6%, early MAR 54.7%, late AMR 23.4%, late MAR 21.1%, p 50% at 14 days was associated with improved DCGS (OR 0.12, 95% confidence interval [CI] 0.02 - 0.52, p = 0.01). CONCLUSION: In summary, significant differences exist across rejection phenotypes with respect to histologic and DSA responses. The data suggest that DSA reduction may be associated with improved DCGS in both early and late AMR.