A retrospective review of the outcome of plasma exchange and aggressive medical therapy in antibody mediated rejection of renal allografts: A single center experience

Al-Badr, Wisam; Kallogjeri, Dorina; Madaraty, Kamel; Oliver, Dana; Bastani, Bahar; Grossman, Brenda J.

doi:10.1002/jca.20181

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Debate continues about exact pathologic diagnostic criteria . AMR complicates the course of about 10% of transplants, depending on the rate of pretransplant sensitization of the transplant population . AMR adversely affects long‐term graft function; 1‐year graft survival varies depending on the treatments used, and most grafts that survive are left with decreased renal function .…”

Section: Renal Diseases and Conditions In Children Treated By Apheresismentioning

confidence: 99%

Apheresis therapy in children: An overview of key technical aspects and a review of experience in pediatric renal disease

Hunt

Jain

Somers

2013

J of Clinical Apheresis

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Although there is less experience with its use in children than adults, apheresis can be a life-saving treatment modality in certain pediatric diseases. With attention to specific technical aspects of the treatment, especially circuit volume, apheresis can be safely performed in children of any age or size. Even in pediatric diseases where it is recognized as an important part of therapy, apheresis is unfortunately still underutilized in North America and there needs to be increased awareness of its role and its availability within the pediatric community. Apheresis has been used particularly in children with certain renal diseases, notably ANCA-associated nephritis, anti-GBM disease, and atypical HUS. In addition, it can improve outcomes in transplantation of children with FSGS and can be part of a pre-transplant strategy for children who are highly sensitized and at high risk for graft failure.

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Section: Renal Diseases and Conditions In Children Treated By Apheresismentioning

confidence: 99%

Apheresis therapy in children: An overview of key technical aspects and a review of experience in pediatric renal disease

Hunt

Jain

Somers

2013

J of Clinical Apheresis

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“…12 Although the role of PLEX has not been confirmed, studies have shown it to be beneficial especially in combination with other agents. 13,14 Other strategies for managing ABMR include the use of rituximab, which targets pre-B cells and B cells, and bortezomib, which is a proteasome inhibitor. 15,16 Uncontrolled randomised studies have shown benefit in both rituximab and bortezomib.…”

Section: Discussionmentioning

confidence: 99%

Successful Salvage Treatment of Resistant Acute Antibody-Mediated Kidney Transplant Rejection with Eculizumab

Khan

Al-Riyami

Abed

et al. 2016

SQUMJ

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Antibody-mediated rejection (ABMR) jeopardises short-and long-term transplant survival and remains a challenge in the field of organ transplantation. We report the first use of the anticomplement agent eculizumab in Oman in the treatment of a 61-year-old female patient with ABMR following a living unrelated kidney transplant. The patient was admitted to the Sultan Qaboos University Hospital in Muscat, Oman, in 2013 on the eighth day post-transplantation with serum creatinine (Cr) levels of 400 µmol/L which continued to rise, necessitating haemodialysis. A biopsy indicated ABMR with acute cellular rejection. No improvement was observed following standard ABMR treatment and she continued to require dialysis. Five doses of eculizumab were administered over six weeks with a subsequent dramatic improvement in renal function. The patient became dialysis-free with serum Cr levels of 119 µmol/L within four months. This case report indicates that eculizumab is a promising agent in the treatment of ABMR.

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“…[1][2][3] Pretransplant sensitization is indeed a major risk factor for acute antibody-mediated rejection (ABMR) after transplant, with an increased risk of allograft loss. [1][2][3][4] Despite its recognition for .20 years as a defined clinicopathologic entity, [4][5][6][7] treatment strategies for acute biopsyproven ABMR are still not standardized. In general, therapeutic strategies have been based on the removal of antidonor alloantibodies (eg, by series of plasmapheresis or immunoadsorption sessions), associated with attempts to suppress antidonor humoral responses (eg, by using intravenous immunoglobulin [IVIg] or the anti-CD20 monoclonal antibody rituximab).…”

mentioning

confidence: 99%

Eculizumab to Treat Antibody-Mediated Rejection in a 7-Year-Old Kidney Transplant Recipient

et al. 2015

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We report on successful early eculizumab administration to treat acute antibody-mediated rejection (ABMR) in a highly sensitized kidney transplant recipient. The recipient is a 7-year-old boy who received, 6 months after a desensitization protocol with monthly intravenous immunoglobulin infusion, a second kidney transplant in the presence of low donor-specific antibodies (DSAs). Both pretransplant lymphocytotoxic and flow cytometric crossmatch were negative. Allograft function recovered promptly, with excellent initial function. On postoperative day (POD) 4, the child developed significant proteinuria with an acute rise in serum creatinine. Allograft biopsy showed severe acute ABMR. Intravenous eculizumab (600 mg), preceded by a single session of plasmapheresis, was administered on POD 5 and 12 along with a 4-day thymoglobulin course. After the first dose of eculizumab, a strikingly rapid normalization of allograft function with a decrease in proteinuria occurred. However, because circulating DSA levels remained elevated, the child received 3 doses of intravenous immunoglobulin (POD 15,16,and 17), with a significant subsequent decrease in DSA levels. At 9 months after transplant, the child continues to maintain excellent allograft function with undetectable circulating DSA levels. This unique case highlights the potential efficacy of using early eculizumab to rapidly reverse severe ABMR in pediatric transplantation, and therefore it suggests a novel therapeutic approach to treat acute ABMR.

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A retrospective review of the outcome of plasma exchange and aggressive medical therapy in antibody mediated rejection of renal allografts: A single center experience

Abstract: Only a shorter interval between transplantation and the acute rejection episode correlated with a good response to PE.

Cited by 3 publications

References 18 publications

Apheresis therapy in children: An overview of key technical aspects and a review of experience in pediatric renal disease

Apheresis therapy in children: An overview of key technical aspects and a review of experience in pediatric renal disease

Successful Salvage Treatment of Resistant Acute Antibody-Mediated Kidney Transplant Rejection with Eculizumab

Eculizumab to Treat Antibody-Mediated Rejection in a 7-Year-Old Kidney Transplant Recipient

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