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논문분류	춘계학술대회 초록집
제목	Impact of early rejection and ABO-incompatible kidney transplantation on chronic antibody-mediated rejection and graft outcome
저자	Ga Young Heo,Beom Seok Kim,Jaeseok Yang
출판정보	2022; 2022(1):
키워드
초록	Objectives: ABO-incompatible (ABOi) kidney transplantation (KT) has a higher rate of early antibody-mediated rejection (ABMR). Early rejection has been reported to be associated with chronic ABMR and poor long-term allograft outcomes. However, it is controversial for association of ABOi KT with chronic ABMR. Methods: We analyzed living-donor KT patients from Severance Hospital and Seoul National University Hospital between January 2010 and December 2019. Cox regression analysis was performed to investigate impact of ABOi KT and early rejection on chronic ABMR and composite kidney outcome (eGFR decline ≥ 50% or graft failure). Results: Among 1,790 patients, there were 1,251 ABO-compatible (ABOc) KT, 323 ABOi KT, and 216 HLA-incompatible (HLAi) KT patients. During a median follow-up of 5.9 years, there were more ABMR within 1 year in the ABOi KT vs. ABOc KT (13.2% vs. 4.8%) with similar acute T-cell mediated rejection (TCMR) (24.9% vs. 29.5%). Both early ABMR and TCMR increased risk for chronic ABMR after 1 year and composite kidney outcome independently of ABOi KT. ABOi KT had a higher risk for de novo DSA production; however, a lower risk for chronic ABMR (aHR 0.55, 95% CI 0.34-0.89) without significant impact on composite kidney outcome after adjustment for early rejection. HLAi KT was not associated with lower risk for chronic ABMR. Conclusions: Although higher incidence of early ABMR could contribute to poor graft outcome in ABOi KT, lower incidence of chronic ABMR might mitigate the bad impact of early ABMR on long-term graft outcome in ABOi KT.
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