title: Immunoadsorption in severe C4d-positive acute kidney allograft rejection: a randomized controlled trial.
abstract: Antibody-mediated rejection (AMR) frequently causes refractory graft dysfunction. This randomized controlled trial was designed to evaluate whether immunoadsorption (IA) is effective in the treatment of severe C4d-positive AMR. Ten out of 756 kidney allograft recipients were included. Patients were randomly assigned to IA with protein A (N = 5) or no such treatment (N = 5) with the option of IA rescue after 3 weeks. Enrolled recipients were subjected to tacrolimus conversion and, if indicated, 'anti-cellular' treatment. All IA-treated patients responded to treatment. One death unrelated to IA occurred after successful reversal of rejection. Four control subjects remained dialysis-dependent. With the exception of one patient who developed graft necrosis, non-responders were subjected to rescue IA, however, without success. Because of a high graft loss rate in the control group the study was terminated after a first interim analysis. Even though limited by small patient numbers, this trial suggests efficiency of IA in reversing severe AMR.
authors.affiliation: Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria. georg.boehmig@meduniwien.ac.at
authors.forename: G A
authors.initials: GA
authors.lastname: Böhmig
authors.forename: M
authors.initials: M
authors.lastname: Wahrmann
authors.forename: H
authors.initials: H
authors.lastname: Regele
authors.forename: M
authors.initials: M
authors.lastname: Exner
authors.forename: B
authors.initials: B
authors.lastname: Robl
authors.forename: K
authors.initials: K
authors.lastname: Derfler
authors.forename: T
authors.initials: T
authors.lastname: Soliman
authors.forename: P
authors.initials: P
authors.lastname: Bauer
authors.forename: M
authors.initials: M
authors.lastname: Müllner
authors.forename: W
authors.initials: W
authors.lastname: Druml
mesh_terms: D000328:Adult; D000368:Aged; D015935:Complement C4b / Q000032:analysis*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009336:Necrosis; D010446:Peptide Fragments / Q000032:analysis*; D006435:Renal Dialysis; D013205:Staphylococcal Protein A / Q000008:administration & dosage / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; D013205:Staphylococcal Protein A; D015935:Complement C4b; C032261:complement C4d; D016559:Tacrolimus