Chronic AMR in Liver Transplant: Validation of the 1-Year cAMR Score's Ability to Determine Long-term Outcome

Jacqueline G. O'Leary, Cory Smith, Juncao Cai, Brent Hart, Linda W. Jennings, Matthew Everly, Goran B. Klintmalm, Anthony J. Demetris

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: A proposed chronic antibody-mediated rejection (AMR) score has recently predicted 50%10-year death-censored allograft loss in patients with donor-specific alloantibodies (DSA) mean florescence intensity (MFI) greater than 10 000 and requires confirmation in patients with lower MFI (1000-10 000).

METHODS: All patients who underwent liver transplantation from January 2000 to April 2009, had DSA (MFI ≥1000) in serum 10 to 14 months postliver transplantation, and had a protocolized liver biopsy were evaluated (n = 230). The previously proposed chronic AMR (cAMR) score was used to risk-stratify putative chronic AMR in DSA+ patients with MFI from 1000 to 10 000.

RESULTS: The MFI distribution of DSA+ recipients were as follows: 66% had MFI 1000 to 4999, 14% had MFI 5000 to 10 000, and 20% had MFI greater than 10 000. The cAMR score distribution on 1-year protocol liver biopsy found that 41% had a score less than 13; 27% a score of 13 to 27.5, and 32% a score greater than 27.5. MFI correlated with 1-year cAMR category (<13, 46% vs 21% and >27.5, 29% vs 42% when MFI was 1000-10 000 vs MFI >10 000; P = 0.047). In patients with a cAMR score less than 13, 10-year death-censored allograft survival was 96% to 100% regardless of MFI (P = NS). The risk of allograft loss increased in patients with a cAMR score greater than 13 (P = 0.004) in DSA+ patients with MFI 1000 to 10 000. DSA MFI greater than 10 000 versus MFI 1000 to 10 000 at 1 year was also more likely to persist at 5 years (95% vs 68%; P < 0.0001).

CONCLUSIONS: Validation of the previously proposed cAMR score in a separate cohort predicts death-censored long-term allograft failure in DSA+ patients regardless of MFI, and higher MFI at 1 year predicts DSA persistence at 5 years.

Original languageEnglish (US)
Pages (from-to)2062-2070
Number of pages9
JournalTransplantation
Volume101
Issue number9
DOIs
StatePublished - Sep 1 2017

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Isoantibodies
Tissue Donors
Transplants
Antibodies
Liver
Allografts
Biopsy
Liver Transplantation
Transplantation

ASJC Scopus subject areas

  • Transplantation

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Chronic AMR in Liver Transplant : Validation of the 1-Year cAMR Score's Ability to Determine Long-term Outcome. / O'Leary, Jacqueline G.; Smith, Cory; Cai, Juncao; Hart, Brent; Jennings, Linda W.; Everly, Matthew; Klintmalm, Goran B.; Demetris, Anthony J.

In: Transplantation, Vol. 101, No. 9, 01.09.2017, p. 2062-2070.

Research output: Contribution to journalArticle

O'Leary, JG, Smith, C, Cai, J, Hart, B, Jennings, LW, Everly, M, Klintmalm, GB & Demetris, AJ 2017, 'Chronic AMR in Liver Transplant: Validation of the 1-Year cAMR Score's Ability to Determine Long-term Outcome', Transplantation, vol. 101, no. 9, pp. 2062-2070. https://doi.org/10.1097/TP.0000000000001802
O'Leary, Jacqueline G. ; Smith, Cory ; Cai, Juncao ; Hart, Brent ; Jennings, Linda W. ; Everly, Matthew ; Klintmalm, Goran B. ; Demetris, Anthony J. / Chronic AMR in Liver Transplant : Validation of the 1-Year cAMR Score's Ability to Determine Long-term Outcome. In: Transplantation. 2017 ; Vol. 101, No. 9. pp. 2062-2070.
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title = "Chronic AMR in Liver Transplant: Validation of the 1-Year cAMR Score's Ability to Determine Long-term Outcome",
abstract = "BACKGROUND: A proposed chronic antibody-mediated rejection (AMR) score has recently predicted 50{\%}10-year death-censored allograft loss in patients with donor-specific alloantibodies (DSA) mean florescence intensity (MFI) greater than 10 000 and requires confirmation in patients with lower MFI (1000-10 000).METHODS: All patients who underwent liver transplantation from January 2000 to April 2009, had DSA (MFI ≥1000) in serum 10 to 14 months postliver transplantation, and had a protocolized liver biopsy were evaluated (n = 230). The previously proposed chronic AMR (cAMR) score was used to risk-stratify putative chronic AMR in DSA+ patients with MFI from 1000 to 10 000.RESULTS: The MFI distribution of DSA+ recipients were as follows: 66{\%} had MFI 1000 to 4999, 14{\%} had MFI 5000 to 10 000, and 20{\%} had MFI greater than 10 000. The cAMR score distribution on 1-year protocol liver biopsy found that 41{\%} had a score less than 13; 27{\%} a score of 13 to 27.5, and 32{\%} a score greater than 27.5. MFI correlated with 1-year cAMR category (<13, 46{\%} vs 21{\%} and >27.5, 29{\%} vs 42{\%} when MFI was 1000-10 000 vs MFI >10 000; P = 0.047). In patients with a cAMR score less than 13, 10-year death-censored allograft survival was 96{\%} to 100{\%} regardless of MFI (P = NS). The risk of allograft loss increased in patients with a cAMR score greater than 13 (P = 0.004) in DSA+ patients with MFI 1000 to 10 000. DSA MFI greater than 10 000 versus MFI 1000 to 10 000 at 1 year was also more likely to persist at 5 years (95{\%} vs 68{\%}; P < 0.0001).CONCLUSIONS: Validation of the previously proposed cAMR score in a separate cohort predicts death-censored long-term allograft failure in DSA+ patients regardless of MFI, and higher MFI at 1 year predicts DSA persistence at 5 years.",
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T1 - Chronic AMR in Liver Transplant

T2 - Validation of the 1-Year cAMR Score's Ability to Determine Long-term Outcome

AU - O'Leary, Jacqueline G.

AU - Smith, Cory

AU - Cai, Juncao

AU - Hart, Brent

AU - Jennings, Linda W.

AU - Everly, Matthew

AU - Klintmalm, Goran B.

AU - Demetris, Anthony J.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - BACKGROUND: A proposed chronic antibody-mediated rejection (AMR) score has recently predicted 50%10-year death-censored allograft loss in patients with donor-specific alloantibodies (DSA) mean florescence intensity (MFI) greater than 10 000 and requires confirmation in patients with lower MFI (1000-10 000).METHODS: All patients who underwent liver transplantation from January 2000 to April 2009, had DSA (MFI ≥1000) in serum 10 to 14 months postliver transplantation, and had a protocolized liver biopsy were evaluated (n = 230). The previously proposed chronic AMR (cAMR) score was used to risk-stratify putative chronic AMR in DSA+ patients with MFI from 1000 to 10 000.RESULTS: The MFI distribution of DSA+ recipients were as follows: 66% had MFI 1000 to 4999, 14% had MFI 5000 to 10 000, and 20% had MFI greater than 10 000. The cAMR score distribution on 1-year protocol liver biopsy found that 41% had a score less than 13; 27% a score of 13 to 27.5, and 32% a score greater than 27.5. MFI correlated with 1-year cAMR category (<13, 46% vs 21% and >27.5, 29% vs 42% when MFI was 1000-10 000 vs MFI >10 000; P = 0.047). In patients with a cAMR score less than 13, 10-year death-censored allograft survival was 96% to 100% regardless of MFI (P = NS). The risk of allograft loss increased in patients with a cAMR score greater than 13 (P = 0.004) in DSA+ patients with MFI 1000 to 10 000. DSA MFI greater than 10 000 versus MFI 1000 to 10 000 at 1 year was also more likely to persist at 5 years (95% vs 68%; P < 0.0001).CONCLUSIONS: Validation of the previously proposed cAMR score in a separate cohort predicts death-censored long-term allograft failure in DSA+ patients regardless of MFI, and higher MFI at 1 year predicts DSA persistence at 5 years.

AB - BACKGROUND: A proposed chronic antibody-mediated rejection (AMR) score has recently predicted 50%10-year death-censored allograft loss in patients with donor-specific alloantibodies (DSA) mean florescence intensity (MFI) greater than 10 000 and requires confirmation in patients with lower MFI (1000-10 000).METHODS: All patients who underwent liver transplantation from January 2000 to April 2009, had DSA (MFI ≥1000) in serum 10 to 14 months postliver transplantation, and had a protocolized liver biopsy were evaluated (n = 230). The previously proposed chronic AMR (cAMR) score was used to risk-stratify putative chronic AMR in DSA+ patients with MFI from 1000 to 10 000.RESULTS: The MFI distribution of DSA+ recipients were as follows: 66% had MFI 1000 to 4999, 14% had MFI 5000 to 10 000, and 20% had MFI greater than 10 000. The cAMR score distribution on 1-year protocol liver biopsy found that 41% had a score less than 13; 27% a score of 13 to 27.5, and 32% a score greater than 27.5. MFI correlated with 1-year cAMR category (<13, 46% vs 21% and >27.5, 29% vs 42% when MFI was 1000-10 000 vs MFI >10 000; P = 0.047). In patients with a cAMR score less than 13, 10-year death-censored allograft survival was 96% to 100% regardless of MFI (P = NS). The risk of allograft loss increased in patients with a cAMR score greater than 13 (P = 0.004) in DSA+ patients with MFI 1000 to 10 000. DSA MFI greater than 10 000 versus MFI 1000 to 10 000 at 1 year was also more likely to persist at 5 years (95% vs 68%; P < 0.0001).CONCLUSIONS: Validation of the previously proposed cAMR score in a separate cohort predicts death-censored long-term allograft failure in DSA+ patients regardless of MFI, and higher MFI at 1 year predicts DSA persistence at 5 years.

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