Table 4.
Individual Cases of AMR
| Onset of AMRa | Follow-up Biopsya | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patient No. |
DGF | POD | Cr, mg/dL |
eGFR, mL/min |
Banff 2017 Score | DSAb | Prozone Detected |
Eculizumab Rx | PLEX, No. |
At 4-6 mo | At 12mo | ||||||||||||
| G | I | T | V | PTC | C4d | Other | Class I |
Class II |
Doses, No. |
Cumulative Dose, mg |
Cr, mg/dL |
eGFR, mL/min |
Biopsy Result |
Cr, mg/dL |
eGFR, mL/min |
Biopsy Result |
|||||||
| 1 | No | 7 | 4.4 | 12 | 1 | 0 | 0 | 0 | 3 | 2 | ATI | 12 184 | 12 779 | No | 9 | 6300 | 10 | 1.3 | 48 | No rejection | 1.4 | 44 | No rejection |
| 2 | No | 7 | 1.8 | 53 | 0 | 0 | 0 | 0 | 0 | 3 | ATI | 19 101 | 0 | No | 11 | 7200 | 12 | 1.1 | 75 | No rejection | 1.3 | 61 | T-cell–mediated rejection (borderline) |
| 3 | No | 8 | 3.6 | 19 | 1 | 0 | 0 | 0 | 2 | 3 | ATI | 9396 | 1780 | Yes | 31 | 30 600 | 12 | 1.9 | 39 | Mixed active AMR and T-cell–mediated rejection (IA) | 1.9 | 39 | CAMR |
| 4 | No | 8 | 1.5 | 36 | 0 | 0 | 0 | 0 | 0 | 3 | ATI | 0 | 27 645 | No | 9 | 6300 | 8 | 1.2 | 46 | – | 1.0 | 57 | Active AMR |
| 5 | No | 10 | 2.5 | 21 | 0 | 0 | 0 | 0 | 1 | 3 | ATI | 1165 | 9798 | No | 5 | 3600 | 7 | 1.7 | 32 | Mixed Active AMR and borderline acute cellular rejection | 1.5 | 45 | No rejection |
| 6 | No | 19 | 2.6 | 32 | 0 | 0 | 0 | 0 | 2 | 3 | ATI | 4156 | 0 | Yes | 2 | 2100 | 2 | 1.8 | 40 | No rejection | 1.6 | 50 | Active AMR |
| 7 | No | 11 | 2.4 | 32 | 2 | 1 | 0 | 2 | 3 | 3 | ATI | 8054 | 431 | No | 8 | 5400 | 8 | 1.2 | 80 | No rejection | 1.5 | 62 | No rejection |
| 8 | No | 11 | 1.7 | 31 | 2 | 0 | 0 | 0 | 1 | 3 | ATI | 13 061 | 0 | No | 1 | 1200 | 1 | 1.6 | 27 | No rejection | 1.9 | 28 | No biopsy performedc |
| 9 | Yes | 7 | 11.5 | 3 | – | – | – | – | – | – | – | 601 | 7347 | Yes | 11 | 8400 | 7 | 1.5 | 36 | – | 1.7 | 40 | – |
| 10 | No | 10 | 2.4 | 21 | 0 | 0 | 0 | 0 | 0 | 3 | ATI | 9283 | 0 | Yes | 4 | 3000 | 4 | 0.9 | 72 | No rejection | .8 | 90 | No rejection |
| 11 | No | 15 | 2.2 | 22 | 0 | 0 | 0 | 0 | 0 | 3 | ATI | 7196 | 0 | No | 1 | 1200 | 0 | 1.2 | 45 | T-cell–mediated rejection (IA) | .9 | 57 | No rejection |
| 12 | Yes | 10 | 7.5 | 8 | 0 | 0 | 0 | 0 | 1 | 3 | ATI | 522 | 8352 | Yes | 4 | 3900 | 0 | 1.9 | 38 | T-cell–mediated rejection (IB) | 1.9 | 38 | No rejection |
| 13 | No | 20 | 1.1 | 54 | – | – | – | – | – | – | – | 7448 | 5028 | No | 2 | 2400 | 0 | 1.2 | 64 | – | – | – | – |
| 14 | No | 10 | 2.4 | 21 | 1 | 0 | 0 | 0 | 0 | 3 | ATI | 2955 | 15 201 | Yes | 10 | 6900 | 3 | 1.8 | 30 | No rejection | – | – | – |
| 15 | Yes | 11 | 9.5 | 5 | 0 | 0 | 0 | 0 | 0 | 3 | ATI | 19 812 | 4808 | Yes | 5 | 3600 | 4 | 1.3 | 54 | No rejection | – | – | – |
Abbreviations: AMR, antibody-mediated rejection; ATI, acute tubular injury; CAMR, chronic active antibody-mediated rejection; Cr, creatinine; DGF, delayed graft function; DSA, donor-specific antibody; eGFR, estimated glomerular filtration rate; MFI, mean fluorescence intensity; PLEX, plasma exchange; POD, post-operative day.
a
Dash indicates not applicable or not available.
b
Sum MFI.
c
No biopsy performed because bowel was overlying allograft on ultrasound.