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Treatment of Antibody‐Mediated Rejection After Kidney Transplantation – 10 Years’ Experience With Apheresis at a Single Center
Author(s) -
Gubensek Jakob,
ButurovicPonikvar Jadranka,
Kandus Aljosa,
Arnol Miha,
Lindic Jelka,
Kovac Damjan,
Rigler Andreja Ales,
Romozi Karmen,
Ponikvar Rafael
Publication year - 2016
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12430
Subject(s) - medicine , immunoadsorption , single center , concomitant , rituximab , immunosuppression , plasmapheresis , kidney transplantation , methylprednisolone , alemtuzumab , transplantation , bortezomib , apheresis , surgery , gastroenterology , antibody , immunology , multiple myeloma , platelet , lymphoma
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.