Long-Term Experience of Plasmapheresis in Antibody-Mediated Rejection in Renal Transplantation

Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
Transplantation Proceedings (Impact Factor: 0.98). 11/2009; 41(9):3690-2. DOI: 10.1016/j.transproceed.2009.06.197
Source: PubMed


Antibody-mediated rejection (AMR) continues to pose a serious challenge in renal transplantation with potentially devastating consequences. Treatment options for this condition include plasmapheresis, high-dose intravenous immunoglobulin (IVIG), plasmapheresis with low-dose IVIG, and the use of rituximab (anti-CD20 chimeric antibody). We previously reported on the short-term outcome of plasmapheresis as a rescue therapy for AMR in our centre. We now report on the long-term follow up.
Over a 2.5-year study period, 440 cadaveric transplants were performed. AMR developed in 20 (4.5%) patients. Treatment included plasmapheresis and intensification of their immunosuppressive therapy.
Excluding two patients who had infarcted their grafts at diagnosis, 18 patients received plasmapheresis treatment for AMR. Of the 18 patients treated, 14 recovered function, two developed graft infarction within a fortnight of starting plasmapheresis, and two patients were withdrawn from treatment. In the 14 who recovered renal function, graft survival was 86% at 12 months. In this study we report on the 5-year follow-up of these AMR-treatment responders. Eleven patients have a functioning graft at 5 years; graft function was stable with a mean serum creatinine of 130 micromol/L at 5 years compared to 123 mumol/L at 1 year. At 5-years follow-up; graft survival was 78% and patient survival 93%.
Little information is available in the literature regarding the long-term outcome of this therapy. This is the first report on the long-term (5-year) follow-up of plasmapheresis as a rescue therapy for AMR.

19 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Circulating antibodies can be eliminated by plasmapheresis. As a conditioning before transplantation, we have used plasmapheresis to remove high titres of panel reactive antibodies in sensitized patients and to decrease AB0 incompatible blood group antibodies before living kidney donation. As a rescue therapy after kidney transplantation, plasmapheresis was used to treat humoral rejection. In all cases, we tempted to inhibit the regeneration of antibodies by additional administration of the B cell antibody rituximab. In 4 of the 8 patients this approach was successful.
    No preview · Article · Jan 2010
  • [Show abstract] [Hide abstract]
    ABSTRACT: Various lineages of B cells are being increasingly recognized as important players in the etiology and prognosis of both acute and chronic graft rejection. The role of immature, chronically activated B cells, as efficient antigen-presenting cells, supporting recalcitrant cell-mediated graft rejection and late lineage B cells driving humoral rejections, is being increasingly recognized. This review captures the recent literature on this subject and discusses the various roles of the B cell in renal graft rejection and conversely, also in graft tolerance, both in animal and human studies. In addition, novel therapies targeting specific B-cell lineages in graft rejection are also discussed, with a view to developing more targeted therapies for graft rejection.
    No preview · Article · Feb 2010 · Transplantation reviews (Orlando, Fla.)
  • [Show abstract] [Hide abstract]
    ABSTRACT: In use for over 50 years, the rationale for plasmapheresis remains based largely on case series and retrospective studies. Recently, results from several randomized controlled trials, meta-analyses, and prospective studies have shown plasmapheresis may be of benefit in various renal diseases, and have provided insights into more rational use of this therapy. A multicenter trial by the European Vasculitis Study Group has shown it is the preferred additional form of therapy for patients with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis and severe renal failure. A recent study conducted at Mayo Clinic also found it effective at reversing renal failure from myeloma-related cast nephropathy if serum free light chain levels were reduced by at least 50%. In addition, a Cochrane review has analyzed the available evidence for its use in thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. The objective of this article is to review recent and past evidence and, thereby, the current indications for treatment in renal disease.
    No preview · Article · Dec 2010 · Journal of Artificial Organs
Show more