Diagnosis and treatment of acute humoral kidney allograft rejection.
Acute humoral rejection (AHR) is a severe form of rejection associated with poor graft survival. Prompt diagnosis and rapid institution of therapy are crucial to improve the prognosis. A therapeutic approach based on plasmapheresis, intravenous imunoglobulin, and rituximab seems to be effective in refractory cases. Herein we have described our experience with 11 patients with biopsy-proven AHR who were treated between January 2005 and June 2008. Seven of these patients had panel reactive antibodies titers more than 50%. The diagnosis was based on Banff 2001 criteria; treatment consisted of a combination of plasmapheresis and intravenous immunoglobulin. Four refractory cases were also treated with a single dose of rituximab. One graft was lost due to thrombosis. All other patients recovered graft function with an average creatinine level of 1.6 mg/dL at 8.6 +/- 2.7 months of follow-up.
Gomes
A M
AM
Nephrology Department, Centro Hospitalar Vila Nova Gaia/Espinho, Gaia, Portugal. ampgomes@gmail.com
Pedroso
S
S
Martins
L S
LS
Malheiro
J
J
Viscayno
J R
JR
Santos
J
J
Dias
L
L
Henriques
A C
AC
Sarmento
A M
AM
Cabrita
A
A
D000208:Acute Disease; D000328:Adult; D000917:Antibody Formation; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous / Q000276:immunology / Q000473:pathology; D055815:Young Adult
D016756:Immunoglobulins, Intravenous; D003404:Creatinine