AUTHOR=Betjes Michiel G. H. , Kal-van Gestel Judith , Roodnat Joke I. , de Weerd Annelies E. 

TITLE=The Incidence of Antibody-Mediated Rejection Is Age-Related, Plateaus Late After Kidney Transplantation, and Contributes Little to Graft Loss in the Older Recipients

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11751

DOI=10.3389/ti.2023.11751

ISSN=1432-2277

ABSTRACT=It is not known whether antibody-mediated rejection (ABMR) is age-related, plateaus late after transplantation and to what extent contributes to graft loss in the older recipients.Patients transplanted between 2010 and 2015 (n=1054) in a single center had regular follow-up until January 2023. Recipients were divided in age groups at transplantation: 18-39 years ("young"), 40-55 years ("middle age") and > 55 years ("elderly") .Ten years after transplantation the cumulative % of recipients with ABMR was 17% in young, 15% in middle age and 12% in elderly recipients (p <0.001). The cumulative incidence of ABMR increased over time and plateaued out 8-10 years after transplantation. In the elderly, with a median follow-up of 7.5 years, on average 30% of the recipients with ABMR had died with a function graft and ABMR contributed only 4% to overall graft loss in this group. These results were cross-validated in a cohort of recipients with >15 years follow-up. Multivariate cox-regression analysis showed that increasing recipient age independently associated with decreasing risk for ABMR .In conclusion, the cumulative risk for ABMR is age-dependent, plateaus late after transplantation and contributes little to overall graft loss in older recipients.