Outcomes of combination therapy for chronic antibody‐mediated rejection in renal transplantation. Issue 12 (26th November 2013)

• Record Type: Journal Article
• Authors: Kim, Myung‐Gyu; Kim, Yoon Jung; Kwon, Hyuk Yong; Park, Hayne Cho; Koo, Tai Yeon; Jeong, Jong Cheol; Jeon, Hee Jung; Han, Miyeun; Ahn, Curie; Yang, Jaeseok
• Is Part Of: Nephrology. Volume 18:Issue 12(2013)
• Page Start: 820
• Page End: 826
• Publication Date: 2013-11-26
• Subjects: Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.12157
• Languages: English
• ISSNs: 1320-5358

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="nep12157-sec-0001" sec-type="section"> <title>Aim</title> <p>Chronic antibody‐mediated rejection (CAMR) in renal transplant patients has poor allograft outcomes. However, treatment strategy has not been established yet. Herein, we present short‐term outcomes of combination therapy for CAMR.</p> </sec> <sec id="nep12157-sec-0002" sec-type="section"> <title>Methods</title> <p>We identified nine patients with CAMR or suspicious CAMR who were treated with antihumoral therapy from 2010 to 2011 and analyzed their medical records retrospectively.</p> </sec> <sec id="nep12157-sec-0003" sec-type="section"> <title>Results</title> <p>Five patients had CAMR, and four patients had suspicious CAMR. Severe transplant glomerulopathy (TG) was observed in seven patients. The estimated glomerular filtration rate (eGFR) was decreased in all patients before treatment. We used three different treatment regimens: (i) high‐dose intravenous immunoglobulin (IVIG) and rituximab; (ii) high‐dose IVIG, rituximab, and bortezomib; and (iii) plasmapheresis with low‐dose IVIG, rituximab and bortezomib. After treatment with one of these three regimens, graft function improved or stabilized in six patients, whereas three patients showed further deterioration of eGFR. The third regimen suppressed deterioration of renal function in all patients. Most patients showed no progression of proteinuria. Infectious complications due to <italic>Pneumocystis jirovecii</italic> pneumonia and herpes zoster occurred in two patients.</p> </sec> <sec id="nep12157-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Combination therapy for CAMR might be effective, even in patients with relatively late‐stage CAMR.</p> </sec> </abstract>