Plasmapheresis and intravenous immunoglobulin in the treatment and prevention of antibody mediated rejection
Abstract
Background: Acute antibody-mediated rejection (AMR) is a rare complication which often results in the loss of kidney graft. The objective of this retrospective monocentric study was to evaluate three different approaches to AMR.
Methods: We retrospectively evaluated data files from 1226 patients who had undergone renal transplantation in 1/2002 - 12/2008. In 2002 - 2003, patients with AMR were treated with 5 plasmaphereses (PP group, n= 13), and in 2004 - 2008 they received 5 PP along with intravenous immunoglobulin (PP+ IVIG, 0.2g/kg, n=21).
Third group consisted of patients with persistence of presence of donor specific antibodies who received a single dose of rituximab (PP+ IVIG+ anti-CD20, n= 11). At 12 months followup data were analyzed.
Results: First year graft survival was significantly higher in the PP+ IVIG group than in PP group (90.5% vs. 46.2%; p= 0.027), similarly patient survival was higher in the same group (95.2% vs. 76.9%; p= 0.001). The incidence of infectious complications was similar.
First year graft survival in rituximab group was 63.5%. Conclusion: In this retrospective single center study the superiority of plasmapheresis and intravenous immunoglobulin was proven in the treatment of early acute antibody-mediated rejection of renal allograft.