Table 1.
Clinical features at the time of transplantation associated with the development of antibody-mediated rejection in univariable Cox proportional hazard regression analyses
| Parameter | Entire cohort (n = 337) | Without ABMR (n = 295) | ABMR# (n = 42) | HR | p value |
|---|---|---|---|---|---|
| Age at KTx, years (median, IQR) | 10.9 (5.3–14.9) | 10.7 (4.9–14.7) | 12.5 (7.9–16.2) | 1.06 (1.01–1.13) | 0.027 |
| 10–15 years1 | 99 (29.4) | 87 (29.5) | 12 (28.6) | 1.39 (0.65–2.97) | 0.395 |
| > 15 years | 80 (23.7) | 66 (22.4) | 14 (33.3) | 2.43 (1.16–5.07) | 0.018 |
| Male sex, n (%) | 202 (59.9) | 174 (59.0) | 28 (66.7) | 1.58 (0.82–3.07) | 0.172 |
| > 1 KTx, n (%) | 41 (12.2) | 32 (10.8) | 9 (21.4) | 2.39 (1.14–5.02) | 0.022 |
| Living donation, n (%) | 102 (30.3) | 88 (29.8) | 14 (33.3) | 1.16 (0.60–2.22) | 0.660 |
| Preemptive donation, n (%) | 83 (24.6) | 70 (23.7) | 13 (31.0) | 1.32 (0.68–2.56) | 0.415 |
| Donor age, years (median, IQR) | 35.0 (14.0–44.0) | 33.0 (13.0–44.0) | 40.0 (17.3–46.8) | 1.02 (1.00–1.04) | 0.102 |
| Cold ischemia time, hours (median, IQR) | 10.0 (3.1–14.8) | 10.2 (3.1–14.8) | 9.51 (3.3–14.6) | 0.98 (0.94–1.03) | 0.393 |
| HLA mismatch, n (mean ± SD) | 2.88 ± 1.31 | 2.83 ± 1.29 | 3.24 ± 1.38 | 1.25 (0.99–1.57) | 0.057 |
| HLA-DR mismatch, n (mean ± SD) | 0.92 ± 0.66 | 0.88 ± 0.66 | 1.14 ± 0.65 | 1.80 (1.13–2.90) | 0.014 |
| Delayed graft function, n (%) | 26 (7.7) | 21 (7.1) | 5 (11.9) | 1.73 (0.68–4.43) | 0.249 |
| Preformed HLA-DSA, n (%) | 25 (7.4) | 18 (6.1) | 7 (16.7) | 2.37 (1.02–5.53) | 0.045 |
| CMV IgG negative recipient and donor, n (%) | 115 (34.1) | 108 (36.6) | 7 (16.7) | 0.39 (0.17–0.88) | 0.024 |
| EBV IgG negative recipient and donor, n (%) | 49 (14.5) | 42 (14.2) | 7 (16.7) | 1.21 (0.54–2.75) | 0.643 |
| Initial immunosuppressive regimen2 | |||||
| Desensitization procedure, n (%) | 13 (3.9) | 12 (4.1) | 1 (2.4) | 0.62 (0.09–4.58) | 0.648 |
| IL-2R antibody induction, n (%) | 145 (43.0) | 128 (43.4) | 17 (40.5) | 0.99 (0.53–1.85) | 0.981 |
| Thymoglobulin, n (%) | 25 (7.4) | 19 (6.4) | 6 (14.3) | 2.83 (1.18–6.76) | 0.019 |
| Rituximab, n (%) | 5 (1.5) | 5 (1.7) | 0 | NA | |
| Tacrolimus, n (%) | 269 (79.8) | 236 (80.0) | 33 (78.6) | 0.84 (0.40–1.77) | 0.647 |
| Ciclosporin, n (%) | 68 (20.2)) | 59 (20.0) | 9 (21.4) | 1.18 (0.57–2.50) | 0.647 |
| Mycophenolate mofetil, n (%) | 293 (86.9) | 258 (87.5) | 35 (83.3) | 0.92 (0.39–2.20) | 0.857 |
| Everolimus, n (%) | 16 (4.8) | 16 (5.4) | 0 | NA | |
| Azathioprine, n (%) | 28 (8.3) | 21 (7.1) | 7 (16.7) | 1.77 (0.74–4.25) | 0.201 |
| Glucocorticoids, n (%) | 328 (97.3) | 287 (97.3) | 41 (97.6) | 0.87 (0.15–5.06) | 0.878 |
ABMR antibody-mediated rejection, DSA donor-specific antibodies, HLA human leukocyte antigen, HR hazard ratio, IL-2R interleukin 2 receptor, KTx kidney transplantation
1Age at KTx < 10 years is the reference group (HR = 1)
2Until day 30 post-transplant
#ABMR group includes acute ABMR, chronic active ABMR, and mixed rejections