Efficacy of Combined Plasmapheresis and Intravenous Immunoglobulin Therapy in Kidney Transplant Patients With Chronic Antibody-mediated Rejection

Iran J Kidney Dis. 2016 May;10(3):151-5.

Abstract

Introduction: Antibody-mediated rejections (AMRs) are critical clinical issues encountered in short- and long-term follow-up of kidney transplant patients. Whereas plasmapheresis is a mainstay treatment option in acute AMR cases, there is a paucity of data regarding its efficacy in management of chronic AMR. This report describes our experience addressing this issue.

Materials and methods: We retrospectively investigated the data of 7 kidney transplant patients diagnosed with chronic AMR who were on 5 sessions of plasmapheresis (1 to 2 volume exchanges with fresh frozen plasma) on alternate days and 200 mg/kg of intravenous immunoglobulin after each session of plasmapheresis.

Results: At 6 months after the initiation of treatment, 6 patients experienced partially improved kidney function. One patient had no response and her kidney function progressively deteriorated.

Conclusions: Our preliminary results are encouraging for the combination of plasmapheresis and intravenous immunoglobulin as an adjunctive therapy for kidney transplant patients suffering from chronic AMR.

MeSH terms

  • Adult
  • Antibodies / immunology
  • Calcineurin Inhibitors / metabolism
  • Chronic Disease
  • Combined Modality Therapy
  • Creatinine / metabolism
  • Female
  • Glomerular Filtration Rate / immunology
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control*
  • Graft Survival / immunology
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Kidney Failure, Chronic / immunology
  • Kidney Failure, Chronic / prevention & control
  • Kidney Transplantation / methods*
  • Male
  • Plasmapheresis / methods*
  • Retrospective Studies
  • Transplantation, Homologous

Substances

  • Antibodies
  • Calcineurin Inhibitors
  • Immunoglobulins, Intravenous
  • Creatinine