title: Local graft irradiation for kidney allograft rejection: a case series and review of the literature.
abstract: BACKGROUND
  Due to its immunosuppressive properties, local graft irradiation (LGI) has been proposed as a second line therapy for treatment of acute kidney rejection.
  
  
  METHODS
  In this case-series we report 6 patients with biopsy proven acute kidney allograft rejection refractory to conventional antirejection therapy who underwent LGI for treatment of acute rejection at our center. Three of these patients had living donor transplants, 2 had deceased donor transplants, and one had received a simultaneous kidney/pancreas transplant. All patients were treated with anti thymocyte-globulin or muromonab-CD3, and intravenous steroids for initial treatment of rejection. Three patients also received intravenous immunoglobulin. LGI was tried as a last resort and was well tolerated and resulted in either improvement or stabilization of renal function in 5 patients. One patient could not be given the complete course of chemical immunosuppression for treatment of rejection due to concomitant cryptococcal meningitis and was switched to LGI with good short-term response.
  
  
  CONCLUSIONS
  Our results suggest that LGI could be considered a second line therapy to the conventional anti-rejection therapy for patients with refractory acute kidney allograft rejection, or for patients who cannot receive systemic immunosuppression due to severe infection.
authors.affiliation: John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, USA ; Division of Nephrology, Department of Medicine, LSUHSC-S, Shreveport, USA.
authors.forename: Mohammad Kazem
authors.initials: MK
authors.lastname: Fallahzadeh
authors.affiliation: Division of Nephrology, Department of Medicine, LSUHSC-S, Shreveport, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Khan
authors.affiliation: John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, USA.
authors.forename: Gazi B
authors.initials: GB
authors.lastname: Zibari
authors.affiliation: John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, USA ; Division of Nephrology, Department of Medicine, LSUHSC-S, Shreveport, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Patil
authors.affiliation: John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, USA ; Division of Nephrology, Department of Medicine, LSUHSC-S, Shreveport, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Singh
keywords: Immunosuppression; Kidney; Radiotherapy; Rejection, Graft; Transplantation