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& nbsp;This study has been partially funded by Redes Tematicas De Investigacion Cooperativa En Salud, REDINREN (RD16/0009/0023) by ISCIII-Subdireccion General de Evaluacion and Fondo Europeo de Desarrollo Regional (FEDER) Una manera de hacer Europa and Secretaria d'Universitats i Recerca and CERCA Programme del Departament d'Economia i Coneixement de la Generalitat de Catalunya (2017-SGR-1331).

Analysis of institutional authors

Palou Ribera, EduardAuthorPineiro, GjAuthorMontagud-Marrahi, EAuthorRios, JAuthorVentura-Aguiar, PAuthorCucchiari, DAuthorLozano, MAuthorCid, JAuthorCofan, FAuthorPalou, EAuthorOppenheimer, FAuthorCampistol, JmAuthorBayes-Genis, BAuthorRovira, JCorresponding AuthorDiekmann, FCorresponding Author

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Article

Influence of Persistent Inflammation in Follow-Up Biopsies After Antibody-Mediated Rejection in Kidney Transplantation

Publicated to:Frontiers In Medicine. 8 (761919): 761919- - 2021-11-12 8(761919), DOI: 10.3389/fmed.2021.761919

Authors: Pineiro, Gaston J; Montagud-Marrahi, Enrique; Rios, Jose; Ventura-Aguiar, Pedro; Cucchiari, David; Revuelta, Ignacio; Lozano, Miquel; Cid, Joan; Cofan, Frederic; Esforzado, Nuria; Palou, Eduard; Oppenheimer, Federico; Campistol, Josep M; Bayes-Genis, Beatriu; Rovira, Jordi; Diekmann, Fritz

Affiliations

Hosp Clin Barcelona, Dept Nephrol & Kidney Transplantat, Barcelona, Spain - Author
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Lab Expt Nefrol & Trasplantament LENIT, Barcelona, Spain - Author
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Med Stat Platform, Barcelona, Spain - Author
Red Invest Renal REDINREN, Madrid, Spain - Author
Univ Barcelona, Hosp Clin Barcelona, Dept Hemotherapy & Hemostasis, Apheresis Unit, Barcelona, Spain - Author
Univ Barcelona, Hosp Clin Barcelona, Dept Immunol, Barcelona, Spain - Author
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Abstract

Background: 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.Methods: 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.Results: 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, P = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, P = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35-14.96), P = 0.01] and tubulitis [HR 2.88 95%CI (1.24-6.69), P = 0.01) in follow-up biopsies significantly increased the risk of graft failure.Conclusion: Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria.Study Registration: Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTRINM-2017-01.

Keywords

antibody-mediated rejectionfollow-up biopsygraft failureinfectious complicationskidney transplantationmicrovascular inflammationpredictorrituximabAntibody-mediated rejectionDonor-specific antibodiesFollow-up biopsyGraft failureInfectious complicationsKidney transplantationMicrovascular inflammationPredictorRituximab

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Frontiers In Medicine due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine (Miscellaneous). Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.98, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-24, the following number of citations:

  • WoS: 5
  • Scopus: 8
  • Europe PMC: 4
  • OpenCitations: 5

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-24:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 14.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 14 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 0.25.
  • The number of mentions on the social network X (formerly Twitter): 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Piñeiro, Gastón Julio) and Last Author (Diekmann, Fritz).

the authors responsible for correspondence tasks have been Rovira Juarez, Jordi and Diekmann, Fritz.