title: Intensive plasmapheresis and intravenous immunoglobulin for treatment of antibody-mediated rejection after kidney transplant.
abstract: OBJECTIVE
  Acute antibody-mediated rejection is an important cause of acute and chronic kidney allograft dysfunction and graft loss. The purpose of the present study was to evaluate our experience using plasmapheresis and intravenous immunoglobulin in treating patients who had acute antibody-mediated rejection after kidney transplant.
  
  
  METHODS
  A retrospective review of 13 patients who had biopsy proven antibody-mediated rejection was performed to determine the efficacy of plasmapheresis and intravenous immuno-globulin with or without bortezomib.
  
  
  RESULTS
  All 13 patients were treated with plasmapheresis (5-18 sessions) with intravenous immunoglobulin (2 ± 1 g/kg) during and/or after plasmapheresis; 6 patients also received bortezomib. Mean age was 43 ± 10 years and median time from transplant to rejection was 4.5 months (interquartile range, 1.25-20 mo). Most patients (11 patients [85%]) had serum creatinine level return to within 20% baseline serum creatinine level before rejection. In all 13 patients, mean hospital length of stay was 27 ± 14 days. Frequency of recurrence of antibody-mediated rejection was 31%, and 1 patient resumed dialysis 7 months after treatment. Mean serum creatinine level was greater before (217 ± 111 μmol/L) than after treatment (141 ± 59 μ mol/L; P ≤ .03).
  
  
  CONCLUSIONS
  The combination of intensive plasmapheresis and intravenous immunoglobulin is effective treatment for antibody-mediated rejection after kidney transplant. Long-term, prospective studies are justified to determine the effect of this regimen on graft survival.
authors.affiliation: From the Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
authors.forename: Prajej
authors.initials: P
authors.lastname: Ruangkanchanasetr
authors.forename: Bancha
authors.initials: B
authors.lastname: Satirapoj
authors.forename: Sumeth
authors.initials: S
authors.lastname: Termmathurapoj
authors.forename: Kesinee
authors.initials: K
authors.lastname: Namkhanisorn
authors.forename: Kongsak
authors.initials: K
authors.lastname: Suaywan
authors.forename: Veerapatr
authors.initials: V
authors.lastname: Nimkietkajorn
authors.forename: Lersan
authors.initials: L
authors.lastname: Luesutthiviboon
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011719:Pyrazines / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001897:Boronic Acids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D011719:Pyrazines; D000069286:Bortezomib; D003404:Creatinine