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A retrospective review of the outcome of plasma exchange and aggressive medical therapy in antibody mediated rejection of renal allografts: A single center experience
Author(s) -
AlBadr Wisam,
Kallogjeri Dorina,
Madaraty Kamel,
Oliver Dana,
Bastani Bahar,
Grossman Brenda J.
Publication year - 2008
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.20181
Subject(s) - medicine , discontinuation , apheresis , single center , plasmapheresis , creatinine , transplantation , retrospective cohort study , dialysis , kidney transplantation , therapeutic plasma exchange , surgery , urology , gastroenterology , antibody , immunology , platelet
Antibody‐mediated rejection (AMR) has been recognized as a major cause of renal allograft loss. Protocols using plasma exchange (PE) to reverse rejection have mixed results. Methods: A retrospective chart review was performed to determine the clinical response to PE inpatients with AMR of renal allograft. A good response to treatment was defined as a decline in serum creatinine (SCr) to within 25% above the prerejection value or discontinuation of dialysis with a SCr <2 mg/dl within 3 months of discharge from the hospital and disappearance of donor‐specific alloantibodies (DSA). Results: Twenty‐two patients, treated with PE for biopsy proven AMR with or without acute‐cellular rejection (ACR), were included in the study. Sixty‐four percent of patients had concurrent AMR and ACR. Fifty‐two percent of all patients had a good response to antirejection therapy, whereas 63% of patients with only AMR and 46% of patients with both AMR and ACR had a good response. Good response to PE did not correlate with the number of plasma volumes exchanged ( P = 0.09), but correlated with a shorter period from transplantation to the rejection episode ( P = 0.002). Conclusion: Only a shorter interval between transplantation and the acute rejection episode correlated with a good response to PE. J. Clin. Apheresis, 2008. © 2008 Wiley‐Liss, Inc.