Treatment of Antibody-Mediated Rejection After Kidney Transplantation - 10 Years' Experience With Apheresis at a Single Center.
Antibody-mediated rejection (AMR) is a major cause of kidney graft failure. We aimed to analyze treatment and outcome of AMR in a national cohort of 75 biopsy-proven acute (43 patients, 57%) or chronic active (32 patients, 43%) AMR episodes between 2000 and 2015. The mean patients' age was 46 ± 16 years, the majority was treated with plasma exchange, 4% received immunoadsorption and 7% received both. The majority received pulse methylprednisolone and low-dose CMV hyperimmune globulin, 20% received bortezomib and 13% rituximab. Concomitant infection was treated in 40% of patients. The immediate treatment outcome was successful in 91%, the 1- and 3-year graft survival rates were 71% and 57%, while 3-year patient survival was 97%. Chronic active AMR was associated with worse graft survival than acute AMR (log rank P = 0.06). To conclude, intensive treatment with apheresis and additional immunosuppression was effective in reversing AMR, but long-term graft survival remains markedly decreased, especially in chronic active AMR.
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Jakob
J
Gubensek
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Jadranka
J
Buturovic-Ponikvar
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Aljosa
A
Kandus
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Miha
M
Arnol
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Jelka
J
Lindic
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Damjan
D
Kovac
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Andreja Ales
AA
Rigler
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Karmen
K
Romozi
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Rafael
R
Ponikvar
D000328:Adult; D000906:Antibodies / Q000276:immunology*; D001781:Blood Component Removal / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods; D010956:Plasmapheresis / Q000379:methods; D013997:Time Factors
D000906:Antibodies; D007166:Immunosuppressive Agents
Adverse effects; Apheresis; Cohort study; Infectious complications; Kidney transplantation; Vascular access