Beneficial effect of plasmapheresis and intravenous immunoglobulin on renal allograft survival of patients with acute humoral rejection.
BACKGROUND
Acute humoral rejection (AHR) has been associated with enhanced graft loss. Our study compared the renal allograft survival of patients with AHR treated with plasmapheresis (PP) and intravenous immunoglobulin (IVIG) with allograft survival in patients with acute cellular rejection (ACR).


METHODS
We retrospectively analyzed all kidney transplants performed at our institution between January 1999 and August 2001 (n=286). Recipients were classified into three groups according to biopsy reports: AHR, ACR, or no rejection. The ACR group was further divided into early and late rejection (<90 and >90 days posttransplant, respectively).


RESULTS
After a mean follow-up of 569+/-19 days, the incidence of AHR was 5.6% (n=16). Recipient presensitization, delayed graft function, early rejection, and higher creatinine at diagnosis were characteristic of AHR. Most AHR patients (14/16) were treated with PP and IVIG. One patient received only IVIG, whereas another received only PP. All AHR patients were given steroid pulses, but only four received antilymphocyte therapy because of concomitant severe ACR. The ACR group comprised 43 patients (15%). One patient with mild rejection received no therapy, 20 improved with steroids alone, and 22 required additional antilymphocyte therapy. One-year graft survival by Kaplan Meier analysis was 81% and 84% in the AHR and ACR groups, respectively (P=NS). Outcomes remained similar when AHR patients were compared with those with early ACR.


CONCLUSIONS
We conclude that AHR, when diagnosed early and treated aggressively with PP and IVIG, carries a short-term prognosis that is similar to ACR.
Rocha
Paulo N
PN
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. rocha001@mc.duke.edu
Butterly
David W
DW
Greenberg
Arthur
A
Reddan
Donal N
DN
Tuttle-Newhall
Janet
J
Collins
Bradley H
BH
Kuo
Paul C
PC
Reinsmoen
Nancy
N
Fields
Timothy
T
Howell
David N
DN
Smith
Stephen R
SR
D000208:Acute Disease; D000328:Adult; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous