Intravitreal Antivascular Endothelial Growth Factor Therapy May Induce Proteinuria and Antibody Mediated Injury in Renal Allografts. Issue 11 (November 2015)

• Record Type: Journal Article
• Authors: Cheungpasitporn, Wisit; Chebib, Fouad T.; Cornell, Lynn D.; Brodin, Michelle L.; Nasr, Samih H.; Schinstock, Carrie A.; Stegall, Mark D; Amer, Hatem
• Is Part Of: Transplantation. Volume 99:Issue 11(2015)
• Publication Date: 2015-11
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000750
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Introduction: Systemic adverse effects of intravenous antivascular endothelial growth factor (VEGF) therapy include: hypertension, proteinuria, renal failure, and thrombotic microangiopathy. Intravitreal therapy with these agents is generally believed to be safe. Methods: We report 2 cases of renal transplant recipients who developed significant allograft dysfunction after the initiation of intravitreal anti-VEGF therapy. Results: The first case is a 67-year-old man with polycystic kidney disease and recipient of a zero-antigen mismatch kidney allograft which developed worsening proteinuria over the first year after transplantation. At 4 months, a biopsy showed only minimal fibrosis and atrophy. At 1 year, an allograft biopsy showed phospholipase A 2 receptor–negative membranous nephropathy. The second patient was a 52-year-old man with tuberous sclerosis who was a recipient of a living related kidney allograft with diminished but stable graft function 16 years from transplantation. After the initiation of intravitreal anti-VEGF therapy, there was an escalating degree of proteinuria. Renal biopsy revealed acute and chronic antibody-mediated rejection with glomerular thrombi and transplant glomerulopathy. Conclusions: These cases, although do not prove causality, point to the need for careful follow-up of renal transplant recipients undergoing intravitreal therapy with anti-VEGF agents. These locally administered agents may play a role in the development of proteinuria and modulate antibody-mediated phenomena. We recommend that in renal transplant recipients undergoing therapy with intravitreal anti-VEGF agents, proteinuria be checked monthly, and there should be a low threshold for performing a biopsy to evaluate for allograft injury. Abstract : Intravitreal anti-vascular endothelial growth factor (VEGF) therapy may induce proteinuria and antibody mediated injury in renal allografts although intravitreal therapy of VEGF is generally believed to be safe and graft biopsy is highly recommended in the VEGF-treated patients with allograft dysfunction.