A retrospective review of the outcome of plasma exchange and aggressive medical therapy in antibody mediated rejection of renal allografts: a single center experience.
Antibody-mediated rejection (AMR) has been recognized as a major cause of renal allograft loss. Protocols using plasma exchange (PE) to reverse rejection have mixed results.


METHODS
A retrospective chart review was performed to determine the clinical response to PE inpatients with AMR of renal allograft. A good response to treatment was defined as a decline in serum creatinine (SCr) to within 25% above the prerejection value or discontinuation of dialysis with a SCr <2 mg/dl within 3 months of discharge from the hospital and disappearance of donor-specific alloantibodies (DSA).


RESULTS
Twenty-two patients, treated with PE for biopsy proven AMR with or without acute-cellular rejection (ACR), were included in the study. Sixty-four percent of patients had concurrent AMR and ACR. Fifty-two percent of all patients had a good response to antirejection therapy, whereas 63% of patients with only AMR and 46% of patients with both AMR and ACR had a good response. Good response to PE did not correlate with the number of plasma volumes exchanged (P = 0.09), but correlated with a shorter period from transplantation to the rejection episode (P = 0.002).


CONCLUSIONS
Only a shorter interval between transplantation and the acute rejection episode correlated with a good response to PE.
Al-Badr
Wisam
W
Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri, USA.
Kallogjeri
Dorina
D
Madaraty
Kamel
K
Oliver
Dana
D
Bastani
Bahar
B
Grossman
Brenda J
BJ
D000293:Adolescent; D000328:Adult; D003401:Creatine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D007518:Isoantibodies; D003401:Creatine