{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T10:22:34Z","timestamp":1781259754822,"version":"3.54.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Retrospective study with kidney recipients diagnosed an active ABMR from January 1, 2004 to December 31, 2019 to explore the influence of persistent inflammation in follow-up biopsies on graft survival after ABMR treatment.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> About 116 patients were included. Active ABMR were treated with a combination of plasma exchange (PE), intravenous immunoglobulin (IVIg), rituximab, and steroids. At 6 months of treatment, 63 (54.3%) patients presented a stabilization or improvement in kidney-graft function. The effectiveness varied depending on the timepoint of the presentation between transplantation and rejection, which is lower for those with late ABMR (63 vs. 21% for early vs. late ABMR, respectively). Ninety patients (77%) underwent a control biopsy after ABMR treatment, from which 46 (51%) responded to the treatment. Microvascular inflammation (MVI) persisted in 64 (71%) biopsies, whereas tubulitis persisted in 17 (19%) biopsies. Death-censored graft survival at 1 year was significantly lower in patients with persistent MVI (86% vs. 95% without persistent MVI, <jats:italic>P<\/jats:italic> = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, <jats:italic>P<\/jats:italic> = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35\u201314.96), <jats:italic>P<\/jats:italic> = 0.01] and tubulitis [HR 2.88 95%CI (1.24\u20136.69), <jats:italic>P<\/jats:italic> = 0.01) in follow-up biopsies significantly increased the risk of graft failure.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria.<\/jats:p><jats:p><jats:bold>Study Registration:<\/jats:bold> Agencia Espa\u00f1ola de Medicamentos y Productos Sanitarios (AEMPS): 14566\/RG 24161. Study code: UTRINM-2017-01.<\/jats:p>","DOI":"10.3389\/fmed.2021.761919","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T05:25:38Z","timestamp":1636694738000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation"],"prefix":"10.3389","volume":"8","author":[{"given":"Gaston 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