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Outcomes of combination therapy for chronic antibody‐mediated rejection in renal transplantation
Author(s) -
Kim MyungGyu,
Kim Yoon Jung,
Kwon Hyuk Yong,
Park Hayne Cho,
Koo Tai Yeon,
Jeong Jong Cheol,
Jeon Hee Jung,
Han Miyeun,
Ahn Curie,
Yang Jaeseok
Publication year - 2013
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12157
Subject(s) - medicine , rituximab , bortezomib , plasmapheresis , combination therapy , regimen , renal function , gastroenterology , kidney transplantation , urology , transplantation , antibody , immunology , surgery , multiple myeloma
Aim Chronic antibody‐mediated rejection ( CAMR ) in renal transplant patients has poor allograft outcomes. However, treatment strategy has not been established yet. Herein, we present short‐term outcomes of combination therapy for CAMR . Methods We identified nine patients with CAMR or suspicious CAMR who were treated with antihumoral therapy from 2010 to 2011 and analyzed their medical records retrospectively. Results Five patients had CAMR , and four patients had suspicious CAMR . Severe transplant glomerulopathy ( TG ) was observed in seven patients. The estimated glomerular filtration rate ( eGFR ) was decreased in all patients before treatment. We used three different treatment regimens: (i) high‐dose intravenous immunoglobulin ( IVIG ) and rituximab; (ii) high‐dose IVIG , rituximab, and bortezomib; and (iii) plasmapheresis with low‐dose IVIG , rituximab and bortezomib. After treatment with one of these three regimens, graft function improved or stabilized in six patients, whereas three patients showed further deterioration of eGFR . The third regimen suppressed deterioration of renal function in all patients. Most patients showed no progression of proteinuria. Infectious complications due to P neumocystis jirovecii pneumonia and herpes zoster occurred in two patients. Conclusion Combination therapy for CAMR might be effective, even in patients with relatively late‐stage CAMR .