Older kidney transplant patients experience less antibody-mediated rejection: a retrospective study of patients with mild to moderate sensitization

Clin Transplant. 2015 Dec;29(12):1090-7. doi: 10.1111/ctr.12632. Epub 2015 Nov 4.

Abstract

Background: There is a paucity of data stratifying by age the incidence of antibody-mediated rejection (AMR) in kidney transplant patients.

Methods: We performed a retrospective study of all adult, renal transplant recipients at a single institution between December 12, 2009, and March 16, 2011. Mildly and moderately sensitized patients were defined as patients with positive donor-specific antibody (DSA) and negative flow cross-match.

Results: One hundred and forty-six patients were determined to have mild to moderate pre-transplantation sensitization. Thirty percent of patients younger than 40 yr of age experienced AMR vs. 15% in the older group (p = 0.04). There was a disproportionate increase in DSA for younger patients at 12 months, particularly for antibodies to class II. Histologic presence of C4d deposition was independently associated with AMR on multivariate analysis.

Conclusions: Following renal transplantation, moderately sensitized patients aged 40 yr old and older were less likely to develop AMR when compared with younger patients.

Keywords: B cell senescence; T cell senescence; antibody mediated rejection; elderly; rejection in aged patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection / blood
  • Graft Rejection / diagnosis
  • Graft Rejection / etiology*
  • Graft Survival
  • Humans
  • Immunization / statistics & numerical data*
  • Isoantibodies / blood*
  • Isoantibodies / immunology
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / surgery*
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prognosis
  • Risk Factors

Substances

  • Isoantibodies