Treatment of Antibody-Mediated Rejection After Kidney Transplantation - 10 Years’ Experience With Apheresis at a Single Center
| Autor: | Miha Arnol, Rafael Ponikvar, Damjan Kovač, Jadranka Buturović-Ponikvar, Andreja Aleš Rigler, Jakob Gubensek, Karmen Romozi, Aljoša Kandus, Jelka Lindič |
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| Rok vydání: | 2016 |
| Předmět: |
Hyperimmune globulin
medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology 030230 surgery Single Center Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Immunoadsorption Kidney transplantation biology business.industry Immunosuppression Hematology medicine.disease Surgery Nephrology Concomitant biology.protein Plasmapheresis Rituximab business medicine.drug |
| Zdroj: | Therapeutic Apheresis and Dialysis. 20:240-245 |
| ISSN: | 1744-9979 |
| DOI: | 10.1111/1744-9987.12430 |
| Popis: | Antibody-mediated rejection (AMR) is a major cause of kidney graft failure. We aimed to analyze treatment and outcome of AMR in a national cohort of 75 biopsy-proven acute (43 patients, 57%) or chronic active (32 patients, 43%) AMR episodes between 2000 and 2015. The mean patients' age was 46 ± 16 years, the majority was treated with plasma exchange, 4% received immunoadsorption and 7% received both. The majority received pulse methylprednisolone and low-dose CMV hyperimmune globulin, 20% received bortezomib and 13% rituximab. Concomitant infection was treated in 40% of patients. The immediate treatment outcome was successful in 91%, the 1- and 3-year graft survival rates were 71% and 57%, while 3-year patient survival was 97%. Chronic active AMR was associated with worse graft survival than acute AMR (log rank P = 0.06). To conclude, intensive treatment with apheresis and additional immunosuppression was effective in reversing AMR, but long-term graft survival remains markedly decreased, especially in chronic active AMR. |
| Databáze: | OpenAIRE |
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