Antibody Mediated Rejection as a Major Cause of Graft Dysfunction

Abstract

Kidney transplantation is the best therapy available for most patients with ESRD. Antibody Mediated Rejection (AMR) in kidney transplantation is a severe complication that frequently occurs after transplantation. We retrospectively analysedhistopathological reports of all patients (23 biopsies in 20 patients) who underwent kidney allograft biopsies for clinical indication, with the goal of understanding the pathology of graft dysfunction. In the early period of 0-6 weeks, 7(77.8%) cases had AMR and 2(22.2%) cases had acute tubular necrosis. In the period of 6 weeks- 6 months, 2(18.2%) cases had AMR, 7(63.6%) cases had mixed T+B cell mediated rejection and 2(18.2%) had features of BK virus nephropathy. In the 6-12 month period, only 1(100%) case had mixed T+B cell mediated rejection. After >12 months, 1(50%) had AMR and another one(50%) had mixed T+B cell mediated rejection. Out of all cases, 10(43.5%) had features of AMR, 9(39.1%) had mixed T+B cell mediated rejection, 2(8.7%) had BK virus nephropathy and another 2(8.7%) had features of ATN. In our study, we found the major cause of graft dysfunction isantibody-mediated rejection. Improvements in long-term renal allograftsurvival will require new and varied approaches specificfor each pathogenic process.