Addition of plasmapheresis decreases the incidence of acute antibody-medited rejection in sensitized patients with strong donor-specific antibodies

被引:77
作者
Akalin, Enver [1 ,2 ]
Dinavahi, Raiani [1 ,2 ]
Friedlander, Rex [3 ]
Ames, Scott [2 ]
de Boccardo, Graciela [1 ,2 ]
Sehgal, Vinita [1 ,2 ]
Schroeppel, Bernd [1 ,2 ]
Bhaskaran, Madhu [1 ,4 ]
Lerner, Susan [2 ]
Fotino, Marileno [3 ]
Murphy, Barbara [1 ,2 ]
Bromberg, Jonathan S. [2 ]
机构
[1] Mt Sinai Med Ctr, Div Renal, New York, NY 10029 USA
[2] Mt Sinai Med Ctr, Recanati Miller Transplantat Inst, New York, NY 10029 USA
[3] Rogosin Inst, Immunogenet Lab, New York, NY USA
[4] N Shore Univ Hosp, Renal Div & Transplant Serv, New York, NY USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2008年 / 3卷 / 04期
关键词
D O I
10.2215/CJN.05321107
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives: The objective of this study was to investigate the effects of desensitization protocols using intravenous Ig with or without plasmapheresis in patients with donor-specific anti-HLA antibodies on prevention of antibody-mediated rejection and downregulation of donor-specific antibodies. Design, setting, participants, & measurements: Thirty-five complement-dependent cytotoxicity T cell cross-match-negative but complement-dependent cytotoxicity B cell and/or flow cytometry cross-match-positive kidney transplant recipients were treated with high-dosage intravenous Ig plus Thymoglobulin induction treatment. Donor-specific antibody strength was stratified as strong, medium, or weak by Luminex flow beads. Group 1 patients had weak/moderate and group 2 strong donor-specific antibodies Results: Whereas no group 1 patients had acute rejection, 66% of group 2 had acute rejection (44% antibody-mediated rejection, 22% cellular rejection). The protocol was then changed to the addition of peritransplantation plasmapheresis to patients with strong donor-specific antibodies (group 3). This change resulted in a dramatic decrease in the acute rejection rate to 7%. During a median 18 mo of follow-up, patient survival was 100, 100, and 93% and graft survival was 100, 78, and 86% in groups 1, 2, and 3, respectively. During follow-up, 17 (52%) patients lost donor-specific antibodies completely, and 10 (30%) lost some of donor-specific antibodies and/or decreased the strength of existing donor-specific antibodies. Conclusions: These results indicated that in patients with strong donor-specific antibodies, the addition of plasmapheresis to high-dosage intravenous Ig decreases the incidence of acute rejection. The majority of the patients, whether they received intravenous Ig alone or with plasmapheresis, lost their donor-specific antibodies during follow-up.
引用
收藏
页码:1160 / 1167
页数:8
相关论文
共 26 条
  • [21] A high panel-reactive antibody rescue protocol for cross-match-positive live donor kidney transplants
    Schweitzer, EJ
    Wilson, JS
    Fernandez-Vina, M
    Fox, M
    Gutierrez, M
    Wiland, A
    Hunter, J
    Farney, A
    Philosophe, B
    Colonna, J
    Jarrell, BE
    Bartlett, ST
    [J]. TRANSPLANTATION, 2000, 70 (10) : 1531 - 1536
  • [22] Treatment of C4D-positive acute humoral rejection with plasmapheresis and rabbit polyclonal antithymocyte globulin
    Shah, A
    Nadasdy, T
    Arend, L
    Brennan, J
    Leong, N
    Coppage, M
    Orloff, M
    Demme, R
    Zand, MS
    [J]. TRANSPLANTATION, 2004, 77 (09) : 1399 - 1405
  • [23] A comparison of plasmapheresis versus high-dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody
    Stegall, MD
    Gloor, J
    Winters, JL
    Moore, SB
    DeGoey, S
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2006, 6 (02) : 346 - 351
  • [24] Effect of induction therapy protocols on transplant outcomes in crossmatch positive renal allograft recipients desensitized with IVIG
    Vo, A. A.
    Toyoda, M.
    Peng, A.
    Bunnapradist, S.
    Lukovsky, M.
    Jordan, S. C.
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2006, 6 (10) : 2384 - 2390
  • [25] Specific and durable elimination of antibody to donor HLA antigens in renal-transplant patients
    Zachary, AA
    Montgomery, RA
    Ratner, LE
    Samaniego-Picota, M
    Haas, M
    Kopchaliiska, D
    Leffell, MS
    [J]. TRANSPLANTATION, 2003, 76 (10) : 1519 - 1525
  • [26] B-cell activity of polyclonal antithymocyte globulins
    Zand, Martin S.
    [J]. TRANSPLANTATION, 2006, 82 (11) : 1387 - 1395