Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation

Details

Serval ID
serval:BIB_EE06268CA6EE
Type
Article: article from journal or magazin.
Collection
Publications
Title
Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation
Journal
Transplantation
Author(s)
Pascual  M., Saidman  S., Tolkoff-Rubin  N., Williams  W. W., Mauiyyedi  S., Duan  J. M., Farrell  M. L., Colvin  R. B., Cosimi  A. B., Delmonico  F. L.
ISSN
0041-1337
Publication state
Published
Issued date
12/1998
Peer-reviewed
Oui
Volume
66
Number
11
Pages
1460-4
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Dec 15
Abstract
BACKGROUND: Acute renal allograft rejection associated with the development of donor-specific alloantibody (acute humoral rejection, AHR) typically carries a poor prognosis. The best treatment of this condition remains undefined. METHODS: During a 14-month period, 73 renal transplants were performed. During the first postoperative month, five recipients (6.8%) with AHR were identified. The diagnosis was based on: (1) evidence of severe rejection, resistant to steroid and antilymphocyte therapy; (2) typical pathologic features; and (3) demonstration of donor-specific alloantibody (DSA) in recipient's serum at the time of rejection. Pretransplant donor-specific T- and B-cell cross-matches were negative. RESULTS: Plasma exchange (PE, four to seven treatments per patient) significantly decreased circulating DSA to almost pretransplant levels in four of five patients, and improvement in renal function occurred in all patients. One patient had recurrent renal dysfunction in the setting of an increase in circulating DSA. A second series of five PE treatments decreased DSA and reversed the rejection episode. Rescue therapy with tacrolimus (initial mean dose: 0.14+/-0.32 mg/kg/day) and mycophenolate mofetil (2 g/day) was used in five of five and four of five patients, respectively. With a mean follow-up of 19.6+/-5.6 months, patient and allograft survival are 100%. Renal function remains excellent with a mean current serum creatinine of 1.2+/-0.3 mg/dl. (range: 0.9-1.8 mg/dl). CONCLUSIONS: Our findings suggest that a therapeutic approach combining PE and tacrolimus-mycophenolate mofetil rescue has the potential to improve the outcome of AHR.
Keywords
Acute Disease Antibody Formation Biopsy Female Graft Rejection/immunology/pathology/prevention & control HLA Antigens/immunology Humans Immunoglobulin G/analysis Immunosuppressive Agents/*therapeutic use Isoantibodies/immunology Kidney/pathology Kidney Transplantation/*immunology Male Middle Aged Mycophenolic Acid/*analogs & derivatives/therapeutic use *Plasma Exchange Tacrolimus/*therapeutic use
Pubmed
Web of science
Create date
29/01/2008 13:53
Last modification date
20/08/2019 16:15
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