title: C4d-positive acute humoral renal allograft rejection: rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil.
abstract: OBJECTIVE
  We investigated the efficacy of immunoadsorption (IA) in combination with tacrolimus (FK506) and mycophenolate mofetil (MMF) rescue therapy for C4d-positive acute humoral rejection (AHR) of renal transplants.
  
  
  METHODS
  Six of 185 cadaveric renal allograft recipients developed AHR at a mean of 4.8 +/- 0.8 days after the operation. C4d deposits were observed in peritubular capillaries (PTC) with accumulation of granulocytes. IA with staphylococcal protein A and FK506-MMF combination therapy were administered.
  
  
  RESULTS
  After treatment with IA for 6.3 +/- 1.03 sessions combined with FK506 (0.14 to 0.16 mg.kg(-1).d(-1)) and MMF (1.5 g/d) therapy, renal function recovered in all the patients. The mean duration of treatment to a serum creatinine decrease was 14 +/- 2.9 days. The pre-IA panel reactive antibody reactivity (PRA) peaked at 50.2% +/- 6.1%, and was significantly reduced to 8.3% +/- 2.9% after IA. In four of six patients repeat allograft biopsy revealed a remission of AHR. With a mean follow-up of 18.8 +/- 5.46 months, patient and allograft survival are 100% and renal function remains stable with a mean serum creatinine of 1.2 +/- 0.22 mg/dL.
  
  
  CONCLUSIONS
  The optimal treatment for alloantibody-mediated AHR remains uncertain. Our findings suggest that a therapeutic approach combining IA and FK506-MMF rescue improves the outcome of AHR.
authors.affiliation: Nanjing University, Nanjing, Peoples Republic of China. Lucky_lm@263.net
authors.forename: M
authors.initials: M
authors.lastname: Liu
authors.forename: S M
authors.initials: SM
authors.lastname: Ji
authors.forename: Zh
authors.initials: Zh
authors.lastname: Tang
authors.forename: D X
authors.initials: DX
authors.lastname: Ji
authors.forename: H P
authors.initials: HP
authors.lastname: Chen
authors.forename: Z H
authors.initials: ZH
authors.lastname: Liu
authors.forename: L S
authors.initials: LS
authors.lastname: Li
mesh_terms: D000208:Acute Disease; D000328:Adult; D000917:Antibody Formation; D015703:Antigens, CD / Q000097:blood* / Q000276:immunology; D015704:CD4 Antigens / Q000097:blood* / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007163:Immunosorbent Techniques; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D015703:Antigens, CD; D015704:CD4 Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D009173:Mycophenolic Acid; D016559:Tacrolimus