Late and Chronic Antibody-Mediated Rejection: Main Barrier to Long Term Graft Survival
Table 1
Early versus late AMR in renal transplant recipients.
Early AMR
Late AMR
Main risk factor
Positive panel reactivity antibody before transplantation, including factors causing sensitization
Withdrawal or reduction of immunosuppressants Noncompliance with immunosuppressive therapy, young age
Antibody
Mostly pre-existing donor-specific antibodies
Mostly de novo donor-specific antibodies, especially HLA class-II antibodies
Clinical features
Very rapid graft dysfunction, significantly decreased urine output, and rapid graft dysfunction
Proteinuria, hypertension, progressive functional deterioration, and overt graft failure
Histology
ATN-like minimal inflammation; capillary and or glomerular inflammation and/or thrombosis; arterial—v3
May have chronic tissue injury, such as glomerular double contours, peritubular capillary basement membrane multilayering, interstitial fibrosis/tubular atrophy, and/or fibrous intimal thickening in arteries
