Incidence, risk factors, treatment, and consequences of antibody-mediated kidney transplant rejection: A systematic review

Allyson Hart, Devender Singh, Sarah Jane Brown, Jeffrey H Wang, Bertram L Kasiske

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations


BACKGROUND: Antibody-mediated rejection (AMR) is a leading cause of kidney allograft failure, but its incidence, risk factors, and outcomes are not well understood.

METHODS: We searched Ovid MEDLINE, Cochrane, EMBASE, and Scopus from January 2000 to January 2020 to identify published cohorts of ≥500 incident adult or 75 pediatric kidney transplant recipients followed for ≥1 year post-transplant.

RESULTS: At least two reviewers screened 5061 articles and abstracts; 28 met inclusion criteria. Incidence of acute AMR was 1.1%-21.5%; most studies reported 3%-12% incidence, usually within the first year post-transplant. Few studies reported chronic AMR incidence, from 7.5%-20.1% up to 10 years. Almost all patients with acute or chronic AMR received corticosteroids and intravenous immunoglobulin; most received plasmapheresis, and approximately half with rituximab. Most studies examining death-censored graft failure identified AMR as an independent risk factor. Few reported refractory AMR rates or outcomes, and none examined costs. Most studies were single-center and varied greatly in design.

CONCLUSIONS: Cohort studies of kidney transplant recipients demonstrate that AMR is common and associated with increased risk of death-censored graft failure, but studies vary widely regarding populations, definitions, and reported incidence. Gaps remain in our understanding of refractory AMR, its costs, and resulting quality of life.

Original languageEnglish (US)
Article numbere14320
Pages (from-to)e14320
JournalClinical Transplantation
Issue number7
StatePublished - May 5 2021

Bibliographical note

Funding Information:
This work was funded by CSL Behring, King of Prussia, PA, USA. However, this manuscript was written by the authors alone.

Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd


  • Adult
  • Child
  • Graft Rejection/epidemiology
  • Graft Survival
  • Humans
  • Incidence
  • Isoantibodies
  • Kidney Transplantation/adverse effects
  • Quality of Life
  • Risk Factors
  • kidney transplant
  • kidney allograft failure
  • antibody-mediated rejection
  • donor-specific anti-human leukocyte antigen antibodies
  • banff criteria

PubMed: MeSH publication types

  • Review
  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Systematic Review


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