Comparison between bortezomib and rituximab in the treatment of antibody-mediated renal allograft rejection

Waiser, Johannes; Budde, Klemens; Schütz, Manuela; Liefeldt, Lutz; Rudolph, Birgit; Schönemann, Constanze; Neumayer, Hans‐H.; Lachmann, Nils

doi:10.1093/ndt/gfr465

Cited by 111 publications

(105 citation statements)

References 29 publications

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“…Ennek modernebb változata az immunadszorpcióval kombinált rMaB-kezelés [31]. A nemzetközi közlések már a PF + IVIG + rMaB kezelést sem tartják elég effektívnek: Waiser és mtsai bortezomib (plazmasejtek apoptózisát indukáló, proteoszómagátló) adását találták haté-konynak rMaB helyett [32]. Debrecenben 2013 óta, a Nefrológiai Tanszék szervezésében lehetségessé vált az AHR adekvát kezelése.…”

Section: áBraunclassified

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

et al. 2016

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Bevezetés: A Debreceni Egyetemen 1991-ben végezték el az első veseátültetést. Hazánk 2013-ban csatlakozott az Eurotransplanthoz. Célkitűzés: A szerzők elemezték a tapasztalatokat. Módszer: 2008. január 1. és 2013. augusztus 31. között (A csoport = 163) és 2013. szeptember 1. és 2015. október 22. között végzett cadavervese-átültetések (B csoport = 90) adatait elemezték. Eredmények: Az élődonorok aránya 3,5%-ról 9,1%-ra nőtt. 2013 óta a recipiensek 25%-a 60 évesnél idősebb, a >30 kg/m 2 testtömegindex aránya 31%-ra, a diabetesesek aránya kétszeresére emelkedett. Az ureteroneocystostomia mellett bevezetésre került a vég az oldalhoz ureteroureteralis anastomosis. Indukciós kezelés mellett az akut rejectiós epizód jelentősen csökkent (34%-ról 8%-ra). A technikai szövődmények aránya nem változott. A bakteriális fertőzések aránya csökkent (41%-ról 33%-ra). Az 1, 3 és 5 éves veseallograft-túlélések 86,6%, 85% és 82,7%, valamint 88%, 84% és 84% voltak a két csoportban. Következtetések: Az extended criteria donor arány emelkedett. 2013 óta lehetségessé vált az akut humoralis rejectio kezelése. Az esetszám-növekedés mellett az eredmények jók. Orv. Hetil., 2016, 157(24), 925-937. Results: The proportion of living transplants rose from 3.5% to 9.1 %. During period B over 25% of utilized donors were over 60 years of age. Recipients with body mass index above 30 kg/m 2 increased from 12% to 31%. Prevalence of diabetes among recipients rose twofold. Uretero-neocystostomy was used during period A (99%) while in period B end to side uretero-ureteral anastomosis has also gained popularity (68%). In 2013 the authors introduced routine use of induction treatment. Acute rejection rate decreased from 34% to 8%. The rate of surgical complications did not change. Acute bacterial infections decreased from 41% to 33%. Cumulative renal allograft 1, 3 and 5 year survival rates were 86.6%, 85% and 82.7% in group A vs. projected rates 88%, 84% and 84% in group B, respectively. Conclusions: Despite the growing proportion of expanded criteria donors, the authors were able to maintain a low incidence of delayed graft function and a favorable graft survival. Since 2013 the authors introduced treatments for acute humoral rejection according to international standards.

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Section: áBraunclassified

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

et al. 2016

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“…5,6,12,14,24,25 This could be achieved with biopsies at the time of transplant; at 90 days, 1 year, and later after transplant; 14 and as indicated clinically. In addition to measuring drug blood levels, crossmatch and donor-specific antibodies may be determined monthly or bimonthly during this period, because the levels of donor-specific antibodies (HLA and MICA) after transplant may follow a dynamic and multidirectional mode similar to that observed before transplant.…”

Section: Monitoring Sensitized Patients After Transplantmentioning

confidence: 99%

“…In addition to measuring drug blood levels, crossmatch and donor-specific antibodies may be determined monthly or bimonthly during this period, because the levels of donor-specific antibodies (HLA and MICA) after transplant may follow a dynamic and multidirectional mode similar to that observed before transplant. 6,12,24,25 This may require the preservation of blood and tissues from the donor spleen in the immunology laboratory. Any central laboratory accredited by the NOOST may have a storage facility in accordance with best practice guidelines.…”

Section: Monitoring Sensitized Patients After Transplantmentioning

confidence: 99%

“…26 Several factors affect the therapeutic response: time of ABMR diagnosis; type of desensitization and immunosuppressive antirejection regimens; level of graft dysfunction; other confounding factors such as coexisting or previous cellular rejection; transplant glomerulopathy; additional renal pathology such as focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, and thrombotic microangiopathy; and poor drug compliance. 20,[24][25][26][27] This may explain the observed variation between centers about reported success frequencies of therapeutic response and graft outcomes. 6,18,[24][25][26] Therapeutic regimens for ABMR are similar to desensitization protocols and vary at different transplant centers.…”

Section: Monitoring Sensitized Patients After Transplantmentioning

confidence: 99%

“…20,[24][25][26][27] This may explain the observed variation between centers about reported success frequencies of therapeutic response and graft outcomes. 6,18,[24][25][26] Therapeutic regimens for ABMR are similar to desensitization protocols and vary at different transplant centers. 4,6,18,19,23,24 They are costly and complex (Table 3).…”

Section: Monitoring Sensitized Patients After Transplantmentioning

confidence: 99%

See 2 more Smart Citations

Approach to Kidney Transplant in Sensitized Potential Transplant Recipients

Barbari

Abbas²,

Jaafar³

2012

Exp Clin Transplant

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More than one-third of patients on waiting lists for kidney transplant are sensitized. Most have previously formed donor-specific and non-donorspecific serum antibodies and/or positive crossmatch by complement-dependent cytotoxity and/or flow cytometry. Two categories of alloantibodies include antibodies against major histocompatibility complex human leukocyte antigen class 1 and class 2 and antibodies against minor histocompatibility complex. A current positive crossmatch is an absolute contraindication for transplant. Positive historical panel reactive antibody and/or donor-specific antibodies (human leukocyte antigen and minor histocompatibility complex), even in the absence of a historical positive crossmatch, are associated with an increased risk for allosensitization, antibodymediated rejection, and accelerated graft failure. Desensitization protocols are numerous, complex, and expensive. It is recommended to perform a systematic determination of historical and current panel reactive antibody, donor-specific antibodies (human leukocyte antigen and minor histocompatibility complex), and crossmatch by the most sensitive assays. The risk of sensitization may be estimated from the combined results of the crossmatch with the donor and those of the recipient's panel reactive antibody and donor-specific antibodies at baseline. The adoption of a scoring system for risk stratification may facilitate the task of organ allocation for sensitized patients. Recipients with an estimated sensitization risk ≥ high may be referred preferably to the national waiting priority list and informed about the financial and the medical risks that may incur with future transplant. Sensitized patients at high risk for antibody-mediated rejection may benefit from a structured monitoring process involving systematic and regular immunologic, histologic, and functional assessments of the graft after transplant. We recommend the adoption and regular updating of these approaches to ensure safe and appropriate therapeutic standards in these sensitized patients, in accordance with best clinical practice.

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Interventions for treating antibody-mediated acute rejection in kidney transplant recipients

Bajpai

Bhatnagar

Charan

et al. 2018

Cochrane Database of Systematic Reviews

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Comparison between bortezomib and rituximab in the treatment of antibody-mediated renal allograft rejection

Cited by 111 publications

References 29 publications

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

Eredményeink a teljes jogú Eurotransplant-tagság óta. A Debreceni Vesetranszplantációs Központ tapasztalatai

Approach to Kidney Transplant in Sensitized Potential Transplant Recipients

Interventions for treating antibody-mediated acute rejection in kidney transplant recipients

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