Management of Chronic Active Antibody-Mediated Rejection in Renal Transplant Recipients: Single-Center Experience

Nair, Prasad; Gheith, Osama; Al-Otaibi, Torki; Mostafa, Mohamed; Rida, Suzann; Sobhy, Islam; Halim, Medhat A; Mahmoud, Tarek; AbdulHameed, Mohamed Diwan M.; Maher, Ayman; Emam, Mohamed

doi:10.6002/ect.mesot2018.o58

Cited by 3 publications

(1 citation statement)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chronic active ABMR is one of the major causes of long-term allograft loss [93][94][95]. Tocilizumab, a humanized monoclonal antibody targeting the interleukin (IL)-6 receptor, has been assessed in patients with acute and chronic active ABMR [96][97][98], given that IL-6 mediates various inflammatory and immunomodulatory pathways, including the expansion and activation of T cells and B cells [98].…”

Section: Active Amrmentioning

confidence: 99%

Recent Advances and Clinical Outcomes of Kidney Transplantation

Hansrivijit

Leeaphorn

Acharya

et al. 2020

JCM

View full text Add to dashboard Cite

Recent advances in surgical, immunosuppressive and monitoring protocols have led to the significant improvement of overall one-year kidney allograft outcomes. Nonetheless, there has not been a significant change in long-term kidney allograft outcomes. In fact, chronic and acute antibody-mediated rejection (ABMR) and non-immunological complications following kidney transplantation, including multiple incidences of primary kidney disease, as well as complications such as cardiovascular diseases, infections, and malignancy are the major factors that have contributed to the failure of kidney allografts. The use of molecular techniques to enhance histological diagnostics and noninvasive surveillance are what the latest studies in the field of clinical kidney transplant seem to mainly focus upon. Increasingly innovative approaches are being used to discover immunosuppressive methods to overcome critical sensitization, prevent the development of anti-human leukocyte antigen (HLA) antibodies, treat chronic active ABMR, and reduce non-immunological complications following kidney transplantation, such as the recurrence of primary kidney disease and other complications, such as cardiovascular diseases, infections, and malignancy. In the present era of utilizing electronic health records (EHRs), it is strongly believed that big data and artificial intelligence will reshape the research done on kidney transplantation in the near future. In addition, the utilization of telemedicine is increasing, providing benefits such as reaching out to kidney transplant patients in remote areas and helping to make scarce healthcare resources more accessible for kidney transplantation. In this article, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.

show abstract

Section: Active Amrmentioning

confidence: 99%

Recent Advances and Clinical Outcomes of Kidney Transplantation

Hansrivijit

Leeaphorn

Acharya

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

Rejection Challenges: Diagnosis and Management

Lang

Riazy

Blydt‐Hansen

2021

Challenges in Pediatric Kidney Transplantation

View full text Add to dashboard Cite

Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia

Joachim

Parajuli

Swanson

et al. 2020

Transplantation Direct

View full text Add to dashboard Cite

Background. The risk of infection associated with specific treatments of chronic active antibody-mediated rejection (cAMR) after kidney transplantation remains unknown. Methods. This was a single-center study of kidney transplant recipients treated with pulse steroids, intravenous immunoglobulin (IVIG) ± rituximab for biopsy-confirmed cAMR. The control group consisted of age- and race-matched patients who underwent donor-specific antibody-based protocol biopsies but had no rejection. We collected data on BK virus (BKV), cytomegalovirus (CMV), urinary tract infection (UTI), and pneumonia postbiopsy. Results. There were 49 patients in each group. In those with cAMR, 21 (43%) were treated with steroids, IVIG, and rituximab; the remaining received steroids and IVIG only. The risk of graft failure was greater in the cAMR group [22 (45%) vs. 3 (6%), P < 0.001]. Kaplan-Meier analyses demonstrated a significantly greater risk of pneumonia in the cAMR group (P = 0.02). This was confirmed by multivariable Cox regression analyses [Hazard ratio (HR) = 6.04, P = 0.027, 95% CI, 1.22-29.75]. None of the patients with pneumonia were affected by opportunistic pathogens. Additionally, the risk of CMV, UTI, and BKV was not increased. Rituximab was not independently associated with any of the infections studied. Conclusions. Treatment of cAMR, but not rituximab, was associated with a 6-fold increased risk of pneumonia. Additional studies are needed to determine the safety and efficacy of prolonged antimicrobial prophylaxis and monitoring strategies, including for hypogammaglobulinemia, to reduce the risk of pneumonia following the treatment of cAMR.

show abstract

Management of Chronic Active Antibody-Mediated Rejection in Renal Transplant Recipients: Single-Center Experience

Cited by 3 publications

References 30 publications

Recent Advances and Clinical Outcomes of Kidney Transplantation

Recent Advances and Clinical Outcomes of Kidney Transplantation

Rejection Challenges: Diagnosis and Management

Treatment of Chronic Active Antibody-mediated Rejection With Pulse Steroids, IVIG, With or Without Rituximab is Associated With Increased Risk of Pneumonia

Contact Info

Product

Resources

About