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Immunoadsorption in Severe C4d‐Positive Acute Kidney Allograft Rejection: A Randomized Controlled Trial
Author(s) -
Böhmig G. A.,
Wahrmann M.,
Regele H.,
Exner M.,
Robl B.,
Derfler K.,
Soliman T.,
Bauer P.,
Müllner M.,
Druml W.
Publication year - 2007
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01613.x
Subject(s) - medicine , immunoadsorption , randomized controlled trial , interim analysis , tacrolimus , refractory (planetary science) , dialysis , kidney , surgery , kidney transplantation , gastroenterology , randomization , antibody , transplantation , immunology , physics , astrobiology
Antibody‐mediated rejection (AMR) frequently causes refractory graft dysfunction. This randomized controlled trial was designed to evaluate whether immunoadsorption (IA) is effective in the treatment of severe C4d‐positive AMR. Ten out of 756 kidney allograft recipients were included. Patients were randomly assigned to IA with protein A (N = 5) or no such treatment (N = 5) with the option of IA rescue after 3 weeks. Enrolled recipients were subjected to tacrolimus conversion and, if indicated, ‘anti‐cellular’ treatment. All IA‐treated patients responded to treatment. One death unrelated to IA occurred after successful reversal of rejection. Four control subjects remained dialysis‐dependent. With the exception of one patient who developed graft necrosis, non‐responders were subjected to rescue IA, however, without success. Because of a high graft loss rate in the control group the study was terminated after a first interim analysis. Even though limited by small patient numbers, this trial suggests efficiency of IA in reversing severe AMR.