Treatment of antibody-mediated rejection including immunoadsorption during first year after renal transplantation--Clinical results and regulation of endothelial progenitor cells.
OBJECTIVE
Antibody-mediated rejection (AMR) is associated with poor allograft survival. Therefore, effective treatment strategies are required. Extracorporeal strategies are increasingly included in treatment of antibody-mediated rejection to eliminate the detrimental alloantibodies. Yet, other mechanisms contributing to the beneficial effect of apheresis besides the removal of antibodies are under consideration.


METHODS
We retrospectively analyzed data of 427 transplant patients from 2006 to 2013 with special focus on occurrence, treatment - always including immunoadsorption - and 12-months outcome of antibody-mediated rejection. Besides, we prospectively monitored how the number and phenotype of endothelial progenitor cells in four patients experiencing antibody-mediated rejection changed during the treatment course of 6-20 sessions of immunoadsorption in comparison to seven patients subjected to immunoadsorption because of preparation for ABO-incompatible transplantation.


RESULTS
24 patients were diagnosed with acute AMR and treated with immunoadsorption resulting in patient and allograft survival of 100% and 87.5%, respectively. In patients with antibody-mediated rejection, the endothelial progenitor cell number after successful immunoadsorption therapy was always transiently decreased and the adhesive and migratory ability improved. This regulation of circulating endothelial precursor cells was not seen in patients undergoing repetitive immunoadsorptions before ABO-incompatible transplantation.


CONCLUSIONS
Combined therapy with immunoadsorption allows a successful treatment of AMR. Treatment seems to be associated with a transient regulation of circulating endothelial precursor cells.
University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Internal Medicine III, Division of Nephrology, Fetscherstraße 74, 01307 Dresden, Germany.
Mirian
M
Opgenoorth
University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Internal Medicine III, Division of Nephrology, Fetscherstraße 74, 01307 Dresden, Germany.
Andrea
A
Wagner
University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Internal Medicine III, Division of Nephrology, Fetscherstraße 74, 01307 Dresden, Germany.
Jens
J
Passauer
University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Internal Medicine III, Division of Nephrology, Fetscherstraße 74, 01307 Dresden, Germany.
Bernd
B
Hohenstein
University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Internal Medicine III, Division of Nephrology, Fetscherstraße 74, 01307 Dresden, Germany. Electronic address: christian.hugo@uniklinikum-dresden.de.
Christian
C
Hugo
D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal / Q000379:methods*; D002448:Cell Adhesion; D002465:Cell Movement; D066026:Endothelial Progenitor Cells / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D056724:Immunity, Humoral; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000017:ABO Blood-Group System; D000906:Antibodies; D015415:Biomarkers; D007166:Immunosuppressive Agents
Antibody-mediated rejection; Endothelial progenitor cells; Immunoadsorption; Renal transplantation