title: Successful rescue therapy with plasmapheresis and intravenous immunoglobulin for acute humoral renal transplant rejection.
abstract: Plasmapheresis (PP) and intravenous immunoglobulin (IVIg) remove donor-specific antibodies, a cause of acute humoral rejection (AHR). We describe the use of PP and IVIg as rescue therapy for AHR. The records of 143 renal transplants performed between October 1, 2000 and April 1, 2002 were reviewed. Patients who underwent PP and IVIg therapy for AHR were identified. The data reviewed included age, sex, source of transplant, number of human leukocyte antigen mismatches, transplant number, number of PP and IVIg treatments, dose of IVIg, time of AHR, serum creatinine (SCr) level at AHR, SCr level after PP and IVIg at 3 months, days to achieve 30% decline in SCr, and graft survival. Immunosuppression included basiliximab induction, tacrolimus, and prednisone (+/- sirolimus or mycophenolate mofetil [CellCept, Roche Pharmaceutical, Nutley, NJ]). PP was followed by IVIg infusion. Nine patients were treated for AHR with PP and IVIg. All nine patients demonstrated biopsy-proven AHR. One graft was lost. Mean 3-month and 1-year SCr levels were 1.9 and 1.8, respectively, in the remaining eight patients. AHR in renal transplantation can be effectively treated with PP and IVIg.
authors.affiliation: Division of Transplantation, Department of Surgery, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2490, USA.
authors.forename: Nicole B
authors.initials: NB
authors.lastname: White
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Greenstein
authors.forename: Alex W
authors.initials: AW
authors.lastname: Cantafio
authors.forename: Richard
authors.initials: R
authors.lastname: Schechner
authors.forename: Daniel
authors.initials: D
authors.lastname: Glicklich
authors.forename: Patricia
authors.initials: P
authors.lastname: McDonough
authors.forename: James
authors.initials: J
authors.lastname: Pullman
authors.forename: Kala
authors.initials: K
authors.lastname: Mohandas
authors.forename: Fouad
authors.initials: F
authors.lastname: Boctor
authors.forename: Joan
authors.initials: J
authors.lastname: Uehlinger
authors.forename: Vivian
authors.initials: V
authors.lastname: Tellis
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents