Novel rescue therapy for C4d-positive acute humoral renal allograft rejection.
OBJECTIVE
To investigate the efficacy of immunoadsorption (IA) in combination with tacrolimus (TAC) and mycophenolate mofetil (MMF) rescue therapy for C4d-positive acute humoral rejection (AHR) of renal transplants.


METHODS
Six of 185 cadaveric renal allograft recipients transplanted at our institute developed AHR over a mean period of 4.8 +/- 0.8 d after operation. The ages ranged from 35 to 51 yr (mean 42.6 +/- 5.6 yr). C4d deposits in peritubular capillaries (PTC) and accumulation of granulocytes in PTC were observed. IA with staphylococcal protein A and TAC-MMF combination therapy were given.


RESULTS
After subjected to IA for 6.3 +/- 1.03 sessions combined with TAC (0.14-0.16 mg/kg/d) and MMF (1.5 g/d) therapy, renal function recovered in all the patients. The mean duration of treatment when serum creatinine decreased was 14 +/- 2.9 d. The pre-IA panel reactive antibody reactivity was as high as 50.2 +/- 6.1%, and was significantly reduced to 8.3 +/- 2.9% after IA. Repeated allograft kidney biopsy in four of six patients revealed a favorable remission of AHR. With a mean follow-up of 18.8 +/- 5.46 months, patient and allograft survival are 100%, renal function remained stable with a mean serum creatinine of 1.2 +/- 0.22 mg/dL.


CONCLUSIONS
The optimal treatment for alloantibody-mediated AHR remains undefined. Our findings suggest that a therapeutic approach combining IA and TAC-MMF rescue has excellence to improve the outcome of AHR.
Min
Liu
L
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. lucky_lm@263.net
Shuming
Ji
J
Zheng
Tang
T
Daxi
Ji
J
Huiping
Chen
C
Zhihong
Liu
L
Leishi
Li
L
D000328:Adult; D000917:Antibody Formation / Q000276:immunology; D015704:CD4 Antigens / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000276:immunology / Q000627:therapeutic use; D016559:Tacrolimus / Q000276:immunology / Q000627:therapeutic use; D016896:Treatment Outcome
D015704:CD4 Antigens; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus