The Banff 2022 consensus introduced probable antibody-mediated rejection (AMR), characterized by mild AMR histologic features and human leukocyte antigen (HLA) donor-specific antibody (DSA) positivity. In a single-center observational cohort study of 1891 kidney transplant recipients transplanted between 2004 and 2021, 566 kidney biopsies were performed in 178 individual HLA-DSA–positive transplants. Evaluated at time of the first HLA-DSA–positive biopsy of each transplant (N = 178), 84 of the 178 (47.2%) of first biopsies were scored as no AMR, 22 of the 178 (12.4%) as probable AMR, and 72 of the 178 (40.4%) as AMR. The majority (77.3%) of probable AMR cases were first diagnosed in indication biopsies. Probable AMR was associated with lower estimated glomerular filtration rate (mL/min/1.73m2) than no AMR (20.2 [8.3-32.3] vs 40.1 [25.4-53.3]; P = .001). The one-year risk of (repeat) AMR was similar for probable AMR and AMR (subdistribution hazard ratio (sHR), 0.99; 0.42-2.31; P = .97) and higher than after no AMR (sHR, 3.05; 1.07-8.73; P = .04). Probable AMR had a higher five-year risk of transplant glomerulopathy vs no AMR (sHR, 4.29; 0.92-19.98; P = 06), similar to AMR (sHR, 1.74; 0.43-7.04; P = .44). No significant differences in five-year risk of graft failure emerged between probable AMR and AMR (sHR, 1.14; 0.36-3.58; P = .82) or no AMR (sHR, 2.46; 0.78-7.74; P = .12). Probable AMR is a rare phenotype, however, sharing significant similarities with AMR in this single-center study. Future studies are needed to validate reproducible diagnostic criteria and associated clinical outcomes to allow for defining best management of this potentially relevant phenotype.

中文翻译：

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肾移植中可能的抗体介导的排斥反应是一种罕见且难以定义的表型： 一项单中心研究的结果


2022 年班夫共识引入了可能的抗体介导的排斥反应 （AMR），其特征是轻度 AMR 组织学特征和人类白细胞抗原 （HLA） 供体特异性抗体 （DSA） 阳性。在一项对 2004 年至 2021 年间移植的 1891 名肾移植受者的单中心观察队列研究中，对 178 例 HLA-DSA 阳性移植进行了 566 例肾活检。在对每次移植进行第一次 HLA-DSA 阳性活检时 （N = 178） 进行评估，第一次活检的 178 例中有 84 例 （47.2%） 被评分为无 AMR，178 例中有 22 例 （12.4%） 为可能的 AMR，178 例中有 72 例 （40.4%） 为 AMR。大多数 （77.3%） 可能的 AMR 病例最初是在适应症活检中诊断的。与无 AMR 相比，可能的 AMR 估计肾小球滤过率 （mL/min/1.73m2） 较低 （20.2 [8.3-32.3] vs 40.1 [25.4-53.3];P = .001）。可能的 AMR 和 AMR 的 （重复） AMR 的一年风险相似（亚分布风险比 （sHR），0.99;0.42-2.31;P = .97），高于无 AMR 后 （sHR， 3.05;1.07-8.73;P = .04）。与无 AMR 相比，可能的 AMR 患移植肾小球病的五年风险更高 （sHR， 4.29;0.92-19.98;P = 06），类似于 AMR （sHR， 1.74;0.43-7.04;P = .44）。可能的 AMR 和 AMR 之间五年移植失败的风险没有显著差异 （sHR，1.14;0.36-3.58;P = .82）或无 AMR （sHR， 2.46;0.78-7.74;P = .12）。然而，可能的 AMR 是一种罕见的表型，与这项单中心研究中的 AMR 具有显著的相似性。需要未来的研究来验证可重复的诊断标准和相关临床结果，以便确定这种潜在相关表型的最佳管理。