Outcomes of combination therapy for chronic antibody-mediated rejection in renal transplantation

Myung-Gyu Kim, Yoon Jung Kim, Hyuk Yong Kwon, Hayne Cho Park, Tai Yeon Koo, Jong Cheol Jeong, Hee Jung Jeon, Miyeun Han, Curie Ahn, Jaeseok Yang

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16 Citations (Scopus)

Abstract

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 Pneumocystis 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.

Original languageEnglish
Pages (from-to)820-826
Number of pages7
JournalNephrology
Volume18
Issue number12
DOIs
Publication statusPublished - 2013 Jan 1

Keywords

  • bortezomib
  • chronic antibody-mediated rejection
  • immunoglobulin
  • plasmapheresis
  • rituximab

ASJC Scopus subject areas

  • Nephrology

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  • Cite this

    Kim, M-G., Kim, Y. J., Kwon, H. Y., Park, H. C., Koo, T. Y., Jeong, J. C., Jeon, H. J., Han, M., Ahn, C., & Yang, J. (2013). Outcomes of combination therapy for chronic antibody-mediated rejection in renal transplantation. Nephrology, 18(12), 820-826. https://doi.org/10.1111/nep.12157