Intravenous immunoglobulin and plasmapheresis in acute humoral rejection: Experience in renal allograft transplantation

被引:35
作者
Lehrich, RW
Rocha, PN
Reinsmoen, N
Greenberg, A
Butterly, DW
Howell, DN
Smith, SR
机构
[1] Duke Univ, Med Ctr, Dept Med, Div Nephrol, Durham, NC 27710 USA
[2] Univ Fed Bahia, Dept Med, Salvador, BA, Brazil
[3] Duke Univ, Med Ctr, Dept Pathol, Durham, NC 27710 USA
关键词
renal allografts; acute humoral rejection; intravenous immunoglobulin; plasmapheresis; allograft survival;
D O I
10.1016/j.humimm.2005.01.028
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Acute humoral rejection (AHR) in kidney transplantation is associated with higher rates of allograft loss when compared with acute cellular rejection (ACR). Treatment with intravenous immunoglobulin (IVIG) combined with plasmapheresis (PP) has been used recently in many centers. We report the incidence, clinical characteristics, and outcome of patients with AHR treated with IVIG and PP. All patients (n = 519) at our institution who underwent kidney transplantation between January 1999 and August 2003 were retrospectively analyzed and classified according to biopsy results into three groups: AHR, ACR, and no rejection. AHR was diagnosed in 23 patients (4.5%) and ACR in 75 patients (15%). Mean follow-up was 844 +/- 23 days. Female sex, black race, and high panel-reactive antibody were risk factors for AHR. Most AHR patients (22 of 23) were treated with IVIG and PP. Two-year graft survival was numerically worse in patients with AHR versus ACR (78% vs. 85%, p = 0.5) but the difference was not statistically significant. Graft survival after AHR treated with IVIG and PP is much better than it has been historically. IVIG in combination with PP is an effective treatment for AHR. Graft survival in this setting is similar to graft survival in patients with ACR. (c) American Society for Histocompatibility and Immunogenetics, 2005. Published by Elsevier Inc.
引用
收藏
页码:350 / 358
页数:9
相关论文
共 42 条
[11]  
GRANDTNEROVA B, 1995, TRANSPLANT P, V27, P934
[12]   THE SIGNIFICANCE OF THE ANTI-CLASS-I ANTIBODY-RESPONSE .1. CLINICAL AND PATHOLOGICAL FEATURES OF ANTI-CLASS I-MEDIATED REJECTION [J].
HALLORAN, PF ;
WADGYMAR, A ;
RITCHIE, S ;
FALK, J ;
SOLEZ, K ;
SRINIVASA, NS .
TRANSPLANTATION, 1990, 49 (01) :85-91
[13]   EXPRESSION AND CONTROL OF THE NATURAL AUTOREACTIVE IGG REPERTOIRE IN NORMAL HUMAN SERUM [J].
HUREZ, V ;
KAVERI, SV ;
KAZATCHKINE, MD .
EUROPEAN JOURNAL OF IMMUNOLOGY, 1993, 23 (04) :783-789
[14]   HUMORAL ANTIBODIES IN RENAL ALLOTRANSPLANTATION IN MAN [J].
JEANNET, M ;
PINN, VW ;
FLAX, MH ;
WINN, HJ ;
RUSSELL, PS .
NEW ENGLAND JOURNAL OF MEDICINE, 1970, 282 (03) :111-&
[15]   Intravenous immune globulin treatment inhibits crossmatch positivity and allows for successful transplantation of incompatible organs in living-donor and cadaver recipients [J].
Jordan, SC ;
Vo, A ;
Bunnapradist, S ;
Toyoda, M ;
Peng, A ;
Puliyanda, D ;
Kamil, E ;
Tyan, D .
TRANSPLANTATION, 2003, 76 (04) :631-636
[16]   Advances in immunology: Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. [J].
Kazatchkine, MD ;
Kaveri, SV .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (10) :747-755
[17]   EVIDENCE DEMONSTRATING POOR KIDNEY GRAFT-SURVIVAL WHEN ACUTE REJECTIONS ARE ASSOCIATED WITH IGG DONOR-SPECIFIC LYMPHOCYTOTOXIN [J].
LOBO, PI ;
SPENCER, CE ;
STEVENSON, WC ;
PRUETT, TL .
TRANSPLANTATION, 1995, 59 (03) :357-360
[18]   Humoral rejection in kidney transplantation: new concepts in diagnosis and treatment [J].
Mauiyyedi, S ;
Colvin, RB .
CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION, 2002, 11 (06) :609-618
[19]  
Mauiyyedi S, 2002, J AM SOC NEPHROL, V13, DOI 10.1681/ASN.V133779
[20]   Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross-match-positive recipients [J].
Montgomery, RA ;
Zachary, AA ;
Racusen, LC ;
Leffell, MS ;
King, KE ;
Burdick, J ;
Maley, WR ;
Ratner, LE .
TRANSPLANTATION, 2000, 70 (06) :887-895