Long-term experience of plasmapheresis in antibody-mediated rejection in renal transplantation

Transplantation Proceedings
C M BrownJ J Walshe

Abstract

Antibody-mediated rejection (AMR) continues to pose a serious challenge in renal transplantation with potentially devastating consequences. Treatment options for this condition include plasmapheresis, high-dose intravenous immunoglobulin (IVIG), plasmapheresis with low-dose IVIG, and the use of rituximab (anti-CD20 chimeric antibody). We previously reported on the short-term outcome of plasmapheresis as a rescue therapy for AMR in our centre. We now report on the long-term follow up. Over a 2.5-year study period, 440 cadaveric transplants were performed. AMR developed in 20 (4.5%) patients. Treatment included plasmapheresis and intensification of their immunosuppressive therapy. Excluding two patients who had infarcted their grafts at diagnosis, 18 patients received plasmapheresis treatment for AMR. Of the 18 patients treated, 14 recovered function, two developed graft infarction within a fortnight of starting plasmapheresis, and two patients were withdrawn from treatment. In the 14 who recovered renal function, graft survival was 86% at 12 months. In this study we report on the 5-year follow-up of these AMR-treatment responders. Eleven patients have a functioning graft at 5 years; graft function was stable with a mean serum cr...Continue Reading

References

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Citations

Jul 3, 2013·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Caitlin E Carter, Nadine M Benador
Dec 15, 2010·Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs·Sanjeev BawejaLawrence P McMahon
Mar 8, 2014·Advances in Chronic Kidney Disease·Ainslie M HildebrandWilliam F Clark
Feb 20, 2013·Journal of Clinical Apheresis·Elizabeth A K HuntMichael J G Somers
Sep 8, 2011·Journal of Clinical Apheresis·Sajid M GeorgeScott L Sanoff
Mar 21, 2012·Seminars in Dialysis·Amber P Sanchez, David M Ward
Apr 28, 2011·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·P ArchdeaconR Albrecht
Aug 13, 2011·Transplant International : Official Journal of the European Society for Organ Transplantation·Gregor BartelGeorg A Böhmig
May 28, 2014·Journal of Clinical Apheresis·Douglas S Keith
Feb 13, 2010·Transplantation Reviews·Valeriya ZarkhinMinnie M Sarwal
Mar 4, 2015·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·L D CornellM D Stegall
Feb 8, 2011·Expert Opinion on Pharmacotherapy·Jessica G LucasKalathil K Sureshkumar
Sep 12, 2014·Current Opinion in Nephrology and Hypertension·Clément GossetDenis Glotz
Jan 18, 2018·Expert Review of Clinical Immunology·Zhulang ChuYong Zhao
Sep 20, 2020·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Catherine JosephPoyyapakkam R Srivaths

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