Therapy with plasmapheresis and intravenous immunoglobulin for acute humoral rejection in kidney transplantation.
BACKGROUND
Acute humoral rejection (AHR) is characterized by acute graft dysfunction associated with de novo production of donor-specific alloantibodies (DSA) and C4d deposition in peritubular capillaries of the renal allograft. It has been reported the combination of plasmapheresis (PP) and intravenous gamma globulin (IVIG) as effective rescue therapy for established AHR.


METHODS
Between 1999 and 2004, seven kidney allografts recipients suffered from AHR diagnosed by severe rejection and C4d staining in peritubular capillaries. All patients had a negative cross-match before renal transplantation.


RESULTS
All patients were treated with daily sessions of PP and in four cases IVIG was added after the last PP session. Tacrolimus and mycophenolate mofetil were employed as maintenance immunosuppressive regimen. In one case, rituximab was added to PP and IVIG owing to refractory humoral rejection. At 1 year, patient survival was 100%, allograft survival was 70%, and the mean serum creatinine was 201 micromol/L.


CONCLUSIONS
AHR is a severe form of rejection associated with a poor prognosis, but its early diagnosis and treatment with PP and IVIG allows reversal of AHR reaching a 70% graft survival at 1 year.
Ibernón
M
M
Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain. meriberon@hotmail.com
Gil-Vernet
S
S
Carrera
M
M
Serón
D
D
Moreso
F
F
Bestard
O
O
Cruzado
J M
JM
Grinyó
J M
JM
D000208:Acute Disease; D000917:Antibody Formation; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000628:therapy*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011379:Prognosis; D014184:Transplantation, Homologous
D016756:Immunoglobulins, Intravenous