Plasma Exchange and Intravenous Immunoglobulin in the Treatment of Antibody-Mediated Rejection After Kidney Transplantation: A Single-Center Historic Cohort Study

2013 ◽  
Vol 45 (4) ◽  
pp. 1524-1527 ◽  
Author(s):  
J. Gubensek ◽  
J. Buturovic-Ponikvar ◽  
A. Kandus ◽  
M. Arnol ◽  
J. Kovac ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Transplantation ◽  
Plasma Exchange ◽  
Intravenous Immunoglobulin ◽  
Single Center ◽  
Antibody Mediated Rejection ◽  
Historic Cohort

scholarly journals Safety and Efficacy of Tandem Hemodialysis and Selective Plasma Exchange in Pretransplant Desensitization of ABO-Incompatible Kidney Transplantation

2021 ◽  
pp. 1-8
Author(s):  
Ako Hanaoka ◽  
Toshihide Naganuma ◽  
Daijiro Kabata ◽  
Daichi Morii ◽  
Yoshiaki Takemoto ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Plasma Exchange ◽  
Treatment Time ◽  
Venous Pressure ◽  
Transmembrane Pressure ◽  
Safety And Efficacy ◽  
Antibody Mediated Rejection ◽  
Tandem Therapy ◽  
Internal Pressures ◽  
Over Time

<b><i>Introduction:</i></b> In patients requiring both hemodialysis (HD) and apheresis, the 2 treatments can be performed simultaneously. At our hospital, selective plasma exchange (SePE) is often performed along with HD for removal of isoagglutinins before ABO-incompatible (ABOi) kidney transplantation. The 2 treatments can be completed within the HD schedule, which allows the treatment time to be shortened. This approach is also less stressful for patients because fewer punctures are required. In this study, we investigated the safety and efficacy of tandem HD and SePE. <b><i>Methods:</i></b> A total of 58 SePE sessions in 30 ABOi kidney transplant recipients were investigated. The SePE circuit was connected in parallel with the HD circuit, and tandem HD and SePE therapy was performed using filtration methods. The SePE sessions were divided into 2 groups: those with SePE monotherapy (group S, <i>n</i> = 20) and those with tandem therapy (group T, <i>n</i> = 38). Changes in transmembrane pressure (TMP), arterial pressure (AP), venous pressure (VP), and decrease in isoagglutinin titers over time were compared between the groups with adjustment for background data. <b><i>Results:</i></b> The internal pressures (AP and VP) were higher in group T, and there were significant differences in changes of TMP and AP over time between groups T and S. Membrane exchange was required in 1 case in group T due to coagulation. There was a more significant decrease of immunoglobulin G isoagglutinin titers in group T compared to group S. No case had antibody-mediated rejection after transplantation. <b><i>Discussion/Conclusion:</i></b> In HD/SePE tandem therapy, internal pressures were higher and TMP and AP tended to increase more compared to SePE monotherapy, but we were able to perform the 2 treatments without any functional problems. Tandem therapy was also effective in decreasing isoagglutinin titers, which suggests that this may be a beneficial treatment modality as apheresis before ABOi kidney transplantation.

scholarly journals Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250829
Author(s):  
Nancy Perrottet ◽  
Mario Fernández-Ruiz ◽  
Isabelle Binet ◽  
Michael Dickenmann ◽  
Suzan Dahdal ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Transplantation ◽  
Real Life ◽  
Severe Infection ◽  
Intravenous Immunoglobulins ◽  
Infectious Complications ◽  
Treatment Recommendation ◽  
Accurate Information ◽  
Significant Heterogeneity ◽  
Antibody Mediated Rejection

Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis.

Antibody-mediated rejection implies a poor prognosis in kidney transplantation: Results from a single center

2018 ◽  
Vol 32 (10) ◽  
pp. e13392 ◽  
Author(s):  
Gaetano Ciancio ◽  
Jeffrey J. Gaynor ◽  
Giselle Guerra ◽  
Junichiro Sageshima ◽  
David Roth ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Poor Prognosis ◽  
Single Center ◽  
Antibody Mediated Rejection

Association Between the Fertile Period and Live Birth Post–Kidney Transplantation: A Retrospective Single-Center Cohort Study

2017 ◽  
Vol 49 (5) ◽  
pp. 1068-1072 ◽  
Author(s):  
Y. Itabashi ◽  
Y. Ohashi ◽  
M. Muramatsu ◽  
T. Kawamura ◽  
Y. Hyodo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Transplantation ◽  
Live Birth ◽  
Single Center ◽  
Fertile Period

scholarly journals P1738COULD ADDING BORTEZOMIB HAVE BENEFIT FOR ANTIBODY MEDIATED REJECTION AFTER KIDNEY TRANSPLANTATION?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nooshin Dalili ◽  
Mohsen Nafar
Keyword(s):  
Kidney Transplantation ◽  
Intravenous Immunoglobulin ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Vascular Inflammation ◽  
Standard Of Care ◽  
Kidney Transplant Recipients ◽  
Standard Regimen ◽  
Antibody Mediated Rejection ◽  
Protocol Biopsies

Abstract Background and Aims Antibody Mediated Rejection (ABMR) is a severe complication that frequently occurs after kidney transplantation. The present RCT designed to evaluate the role of adding Bortezomib to standard regimen with plasma exchange, intravenous immunoglobulin and Rituximab in treatment of AMR after kidney transplantation. Method 26 kidney transplant recipients (KTRs) with a biopsy proven diagnosis of AMR and positive DSA in a randomized clinical trial were compared: Thirteen KTRs treated with plasmapheresis, intravenous immunoglobulin and rituximab (PE-IVIG- RTX ) plus bortezomib versus 13 patients treated with standard of care regimen without bortezomib. We evaluated graft survival and DSA titer with MFI during a year after biopsy proven diagnosis. Results Statistical difference in graft survival between the two groups was noted: three out of 13 patients in the PE-IVIG-RTX group (23%) and 1/13 in the bortezomib group (7.5%) experienced loss of allograft function at a median time after diagnosis of 6 month and 12 month, respectively. DSA MFI titers 12 month after AMR diagnosis showed significant reducing slope in Bortezomib group. Regarding pathological changes micro vascular inflammation (glomerulitis + peritubular capillaritis score) reduced after PE-IVIG- RTX plus bortezomib in 7 out of 13 patients whom underwent protocol biopsies after treatment (53%) (Median score 3 in pre- treatment biopsy vs. 1 in post-treatment biopsy; P = 0.036). Conclusion Although DSA titer may not differ at 6 months after treatment of AMR between those who received standard regimen and those treated with adding Bortezomib, but at the end of one year patients treated with standard regimen plus Bortezomib reached lower MFI DSA titer. Adding Bortezomib to PE-IVIG- RTX for the treatment of AMR after kidney transplantation may enable clinicians to fight the DSA better and change the future of next generation of highly sensitized kidney transplant candidates.

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