The role of therapeutic apheresis in the treatment of acute antibody‐mediated kidney rejection

Abstract

Approximately 10% of renal transplant recipients experience acute antibody-mediated rejection (AMR) due to alloimmunization against human leukocyte antigen (HLA) molecules and other antigens. While therapeutic apheresis is included in most treatment protocols for acute kidney allograft rejection, these protocols have been derived mainly from single center experience rather than controlled trials. This concise review focuses on the role of therapeutic apheresis in AMR treatment. Two groups have recently reported treating acute AMR using drug-only strategies without therapeutic apheresis in particular situations, namely in clinically less severe cases or in resource-limited situations without testing for donor specific antibodies. A randomized controlled trial, designed to test the efficacy of immunoadsorption apheresis in AMR treatment, was terminated early and suggested a benefit of apheresis. An observational study suggested efficacy of plasmapheresis in acute AMR treatment, but all patients who received plasmapheresis also received rituximab. As new therapeutic modalities are becoming available, therapeutic apheresis continues to play a role in the treatment of acute kidney allograft rejection.

An Anti-C1s Monoclonal, TNT003, Inhibits Complement Activation Induced by Antibodies Against HLA

“…Traditional interventions, such as plasmapheresis and intravenous immunoglobulin (IVIG), are used to decrease antibody levels and inhibit antibody function, respectively (94,95). Newer targeted therapies have focused on modulating complement proteins directly.…”

“…Current therapies are used in combination to treat the multi-faceted pathophysiology of AMR, as there appears to be no clear panacea (92,93). Traditional interventions, such as plasmapheresis and intravenous immunoglobulin (IVIG), are used to decrease antibody levels and inhibit antibody function, respectively (94,95). Newer targeted therapies have focused on modulating complement proteins directly.…”

Therapeutischer Plasmaaustausch und Immunadsorption – Indikationen in der Nephrologie und Neurologie

“…Auch im Rahmen von blutgruppengleichen Nierentransplantationen spielen Plasmatherapien eine wichtige Rolle. Vergleichbar mit der Situation bei der blutgruppenungleichen Nierentransplantation können sowohl die PP [24] als auch die IA [25] erfolgreich im Bereich der humoralen Rejektion eingesetzt werden, die insbesondere durch donorspezifische HLA-Antikörper (DSA) ausgelöst wird. Neben diesem Einsatz werden die PP und die IA auch zur Vorbereitung von Lebendspenden genutzt, wenn der Empfänger bereits vor der Lebendspende präformierte donorspezifische HLA-Antikörper bildet.…”

Therapeutic plasma exchange for the treatment of pediatric renal diseases in 2013

“…At Cedars-Sinai TPE is used in severe AMR, including those cases of patients showing a rapid decline in renal function and more severe abnormalities on kidney biopsy, while patients with less severe cases are treated with medical therapy (pulse steroids, IVIG and rituximab) [29]. Other centers include TPE as part of the regimen for all cases of AMR [30]. AMR generally responds well, and recovery of renal function has been reported in >80 % of patients for whom TPE was included in their therapy [31][32][33].…”