Immunoadsorption in severe C4d-positive acute kidney allograft rejection: a randomized controlled trial.
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.
Böhmig
G A
GA
Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria. georg.boehmig@meduniwien.ac.at
Wahrmann
M
M
Regele
H
H
Exner
M
M
Robl
B
B
Derfler
K
K
Soliman
T
T
Bauer
P
P
Müllner
M
M
Druml
W
W
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
D010446:Peptide Fragments; D013205:Staphylococcal Protein A; D015935:Complement C4b; C032261:complement C4d; D016559:Tacrolimus