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

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) >10 000 and requires confirmation in patients with lower MFI (1000-10 000). Methods: All patients who underwent liver transplantation (LT) from 1/00-4/09, had DSA (MFI >=1000) in serum 10-14 months post-LT, 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 1000-10 000. Results: The MFI distribution of DSA+ recipients were as follows: 66% had MFI 1000-4999, 14% had MFI 5000-10 000 and 20% had MFI >10 000. The cAMR score distribution on 1-year protocol liver biopsy was found to be: 41% had a score 27.5. MFI correlated with 1-year cAMR category (27.5, 29% vs. 42% when MFI was 1000-10 000 vs. MFI >10 000; p=0.047). In patients with a cAMR score 13 (p=0.004) in DSA+ patients with MFI 1000-10 000. DSA MFI>10 000 vs. MFI 1000-10 000 at 1-year was also more likely to persist at 5-years (95% vs. 68%; p

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