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Differences in histologic response between early and late antibody mediated rejection therapy: assessment by Banff component scoring

Sadaka, Basma

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2013, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
OBJECTIVE: To analyze Banff component scoring in early and late antibody mediated rejection (AMR) treated with a proteasome inhibitor-based regimen as a mean for assessing therapeutic response in kidney transplant recipients. METHODS: AMR was diagnosed using Antibody Working Group criteria. Biopsies were performed within 48 hours prior to and 14-21 days after AMR therapy initiation. Banff component scoring was performed using Banff '97 criteria (update 2007). C4d capillary staining was considered positive if either focal or diffuse. Early AMR was defined as occurring within 6 months post-transplant and late AMR beyond 6 months. Early and late AMR were treated with a standardized regimen including 4 bortezomib doses (1.3 mg/m²) over 11 days with each dose immediately preceded by plasmapheresis and a single rituximab dose (375 mg/m²). RESULTS: Fifty-five patients underwent AMR therapy (early AMR (n=18) and late AMR (n=37)). Composite Banff component scoring on initial AMR biopsy demonstrated that late AMR patients, as compared to early AMR patients, had higher t, i, and acute composite scores and higher ci, ct, cg, cv and chronic composite scores. In the entire patient population, AMR treatment provided statistically significant improvement in most individual acute component scores (t, i, g, ptc but not v) and in the acute composite score (t+i+g+v+ptc), but not individual chronic component scores (ct, ci, cg, and cv) or chronic composite score (ct+ci+cg+cv). C4d scoring also decreased significantly with AMR therapy. When analyzed separately, early and late AMR patients demonstrated differential histologic responses to AMR therapy. Early AMR patients demonstrated numerical (but not statistically significant) trends toward improvement in individual acute component and acute composite scoring, and statistically significant deterioration in ct, ci and chronic composite scores. Late AMR patients demonstrated significant improvements only in acute t and i scores, but not acute composite scores or individual chronic component or chronic composite scores. CONCLUSION: Acute and chronic Banff component scoring demonstrates differences in early and late AMR at diagnosis and in response patterns to AMR therapy. These results indicate that Banff component scoring may provide a means for assessing AMR therapeutic responses in clinical.
Paul Succop, Ph.D. (Committee Chair)
Rita Alloway, Pharm.D. (Committee Member)
Ervin Steve Woodle, M.D. (Committee Member)
30 p.

Recommended Citations

Citations

  • Sadaka, B. (2013). Differences in histologic response between early and late antibody mediated rejection therapy: assessment by Banff component scoring [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1367925543

    APA Style (7th edition)

  • Sadaka, Basma. Differences in histologic response between early and late antibody mediated rejection therapy: assessment by Banff component scoring. 2013. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1367925543.

    MLA Style (8th edition)

  • Sadaka, Basma. "Differences in histologic response between early and late antibody mediated rejection therapy: assessment by Banff component scoring." Master's thesis, University of Cincinnati, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1367925543

    Chicago Manual of Style (17th edition)