Rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil for C4d-positive acute humoral renal allograft rejection.
The aim of this study was to investigate the efficacy of immunoadsorption (IA) in combination with tacrolimus (TAC; 0.14 to 0.16 mg/kg/d) and mycophenolate mofetil (MMF; 1.5 to 2.0 g/d) rescue therapy for C4d-positive acute humoral rejection in nine cadaveric renal allograft recipients. Initial Panel reactive antibody (PRA-I and PRA-II levels were as high as 28.8% +/- 16.2% and 15.3% +/- 8.9%, IA therapy significantly decreased PRA-I and PRA-II levels to 5.9% +/- 2.9% and 2.2% +/- 0.6%, respectively. Total serum immunoglobulin levels were markedly decreased. Repeated allograft renal biopsy in nine patients revealed remission of acute humoral rejection (AHR), and the deposition of C4d disappeared and reduced. With a mean follow-up of 29.4 +/- 5.4 months, patient and allograft survivals were 100%, and renal function remained stable with a mean serum creatinine of 1.1 +/- 0.3 mg/dL. Our findings suggested that a therapeutic approach combining IA and TAC and MMF rescue improved the outcomes of AHR.
Ji
S-M
SM
Research Institute of Nephrology, Jinling Hospital, Nanjing, China. jishuming@vip.163.com
Liu
Z-H
ZH
Chen
J-S
JS
Sha
G-Z
GZ
Ji
D-X
DX
Li
L-S
LS
D000208:Acute Disease; D000328:Adult; D000917:Antibody Formation; D015935:Complement C4b / Q000032:analysis*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D007163:Immunosorbent Techniques; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010446:Peptide Fragments / Q000032:analysis*; D012086:Reoperation / Q000706:statistics & numerical data; D016559:Tacrolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous
D006680:HLA Antigens; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d; D009173:Mycophenolic Acid; D016559:Tacrolimus