title: Plasmapheresis, Photopheresis, and Endovenous Immunoglobulin in Acute Antibody-mediated Rejection in Kidney Transplantation.
abstract: BACKGROUND
  Acute antibody-mediated rejection (AAMR) is the subject of much research. It is diagnosed by C4d staining at biopsy and circulating donor-specific antibodies (DSA). The combination of intensive plasmapheresis and intravenous immunoglobulin (IVIG) has been recognized as an effective treatment for AAMR. We report our single-center experience on AAMR treatment.
  
  
  METHODS
  We treated 23 transplanted patients (group A) with protein-A immunoadsorption (IA) and 7 patients (group B) with double-filtration plasmapheresis. All patients were treated with IVIG (400 mg/kg/d). Basic immunosuppression included cyclosporine, steroids, azathioprine, and antilymphocyte globulin or monoclonal antibodies (OKT3). A subgroup of 3 patients (3/7; group B1) was treated with photopheresis.
  
  
  RESULTS
  In both groups, the mean number of extracorporeal procedures was 7.3 ± 4.5 and 5.5, respectively; the mean duration of treatment was 12.3 ± 10.2 and 14.5 days, respectively. In group A, we observed negative cross-matching in 96% after mean of 18 days; 1 patient died from sepsis, and 6 lost their grafts. In group B, negative circulating DSA were observed in all patients after a mean of 25 days, and 1 patient lost their allograft.
  
  
  CONCLUSIONS
  In our observation, the 2 extracorporeal procedures had similar effects in terms of graft survival, DSA removal, and cross-match negativity (group A 74% vs 86%; 95.6% vs 100%). IA was faster for DSA removal. In our opinion, the higher costs of IA suggests its use just in high-risk cases, such as in hyperimmune or sensitized patients. Further studies are necessary to improve our knowledge.
authors.affiliation: UOC Chirurgia Generale e Trapianti di Organo, Sapienza, Rome, Italy. Electronic address: renzo.pretagostini@hotmail.it.
authors.forename: R
authors.initials: R
authors.lastname: Pretagostini
authors.affiliation: UOC Chirurgia Generale e Trapianti di Organo, Sapienza, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Poli
authors.affiliation: UOC Centro Trasfusionale. Umberto I Policlinico di Roma, Sapienza, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gozzer
authors.affiliation: UOC Nefrologia, Ospedale Sant'Andrea - Sapienza Università di Roma, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pettorini
authors.affiliation: UOC Chirurgia Generale e Trapianti di Organo, Sapienza, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Garofalo
authors.affiliation: Dipartimento di Ingegneria Meccanica e Areospaziale, Sapienza Università di Roma, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Novelli
authors.affiliation: UOC Chirurgia Generale e Trapianti di Organo, Sapienza, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cinti
authors.affiliation: UOC Chirurgia Generale e Trapianti di Organo, Sapienza, Rome, Italy.
authors.forename: P B
authors.initials: PB
authors.lastname: Berloco
mesh_terms: D000328:Adult; D000906:Antibodies / Q000009:adverse effects / Q000097:blood / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000706:statistics & numerical data*; D010956:Plasmapheresis / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000906:Antibodies; D016756:Immunoglobulins, Intravenous