Splenic Irradiation for the Treatment of Severe Antibody‐Mediated Rejection. Issue 10 (27th June 2016)

• Record Type: Journal Article
• Authors: Orandi, B. J.; Lonze, B. E.; Jackson, A.; Terezakis, S.; Kraus, E. S.; Alachkar, N.; Bagnasco, S. M.; Segev, D. L.; Orens, J. B.; Montgomery, R. A.
• Is Part Of: American journal of transplantation. Volume 16:Issue 10(2016:Oct.)
• Page Start: 3041
• Page End: 3045
• Publication Date: 2016-06-27
• Subjects: clinical research/practice -- kidney transplantation/nephrology -- immunosuppression/immune modulation -- histocompatibility -- alloantibody -- desensitization -- rejection: antibody‐mediated (ABMR) -- intravenous immunoglobulin/IVIG -- plasmapheresis/plasma exchange; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13882
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Patients requiring desensitization prior to renal transplantation are at risk for developing severe antibody‐mediated rejection (AMR) refractory to treatment with plasmapheresis and intravenous immunoglobulin (PP/IVIg). We have previously reported success at graft salvage, long‐term graft survival and protection against transplant glomerulopathy with the use of eculizumab and splenectomy in addition to PP/IVIg. Splenectomy may be an important component of this combination therapy and is itself associated with a marked reduction in donor‐specific antibody (DSA) production. However, splenectomy represents a major operation, and some patients with severe AMR have comorbid conditions that substantially increase their risk of complications during and after surgery. In an effort to spare recipients the morbidity of a second operation, we used splenic irradiation in lieu of splenectomy in two incompatible live donor kidney transplant recipients with severe AMR in addition to PP/IVIg, rituximab and eculizumab. This novel approach to the treatment of severe AMR was associated with allograft salvage, excellent graft function and no short‐ or medium‐term adverse effects of the radiation therapy. One‐year surveillance biopsies did not show transplant glomerulopathy (tg) on light microscopy, but microcirculation inflammation and tg were present on electron microscopy. Abstract : The authors report the novel use of splenic irradiation in lieu of splenectomy in two HLA‐incompatible live donor kidney transplant recipients with severe, plasmapheresis/IVIg‐refractory antibody‐mediated rejection, with successful allograft salvage, excellent graft function, and no adverse effects of radiation, though 1‐year protocol biopsies showed microcirculation injury.