Treatment of Acute Antibody-Mediated Rejection: A Single-Center Experience

Ferrero, Marisa Rodríguez; Rincón, A.; Bucalo, Laura; Rementería, A.; Anaya, Fernando

doi:10.1016/j.transproceed.2010.07.068

Cited by 10 publications

(2 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four months after transplantation, 6 patients remained FCXM + , and nine of 11 tested in the multiplexed bead assay were positive for DSA. As with high dose IVIG, PP combined with low dose IVIG has also been used to treat AMR successfully (55,56,(61)(62)(63)(64).…”

Section: Plasmapheresis and Low Dose Ivigmentioning

confidence: 99%

Desensitization for solid organ and hematopoietic stem cell transplantation

Zachary

Leffell

2014

Immunological Reviews

View full text Add to dashboard Cite

Desensitization protocols are being used worldwide to enable kidney transplantation across immunologic barriers, i.e. antibody to donor HLA or ABO antigens, which were once thought to be absolute contraindications to transplantation. Desensitization protocols are also being applied to permit transplantation of HLA mismatched hematopoietic stem cells to patients with antibody to donor HLA, to enhance the opportunity for transplantation of non-renal organs, and to treat antibody-mediated rejection. Although desensitization for organ transplantation carries an increased risk of antibody-mediated rejection, ultimately these transplants extend and enhance the quality of life for solid organ recipients, and desensitization that permits transplantation of hematopoietic stem cells is life saving for patients with limited donor options. Complex patient factors and variability in treatment protocols have made it difficult to identify, precisely, the mechanisms underlying the downregulation of donor-specific antibodies. The mechanisms underlying desensitization may differ among the various protocols in use, although there are likely to be some common features. However, it is likely that desensitization achieves a sort of immune detente by first reducing the immunologic barrier and then by creating an environment in which an autoregulatory process restricts the immune response to the allograft.

show abstract

Section: Plasmapheresis and Low Dose Ivigmentioning

confidence: 99%

Desensitization for solid organ and hematopoietic stem cell transplantation

Zachary

Leffell

2014

Immunological Reviews

View full text Add to dashboard Cite

show abstract

“…As a result for the first time, antibody levels can be followed prospectively during treatment. The treatment of antibody‐mediated rejection is largely based on case series and poorly controlled randomized trials that typically included multiple simultaneous treatments including apheresis . Nevertheless, apheresis appears to be an important modality in the treatment of antibody‐mediated rejection.…”

Section: Apheresis For the Treatment Of Antibody‐mediated Kidney Rejementioning

confidence: 99%

Therapeutic apheresis in renal transplantation; current practices

Keith

2014

J of Clinical Apheresis

View full text Add to dashboard Cite

Apheresis is an important treatment modality for the removal of pathologic antibodies and circulating proteins in kidney transplantation. The use of apheresis has been shown to be a necessary preconditioning component in ABO incompatible kidney transplant. Removal of pathologic anti-A and anti-B antibodies has been accomplished with a variety of apheresis modalities including plasma exchange, fractional plasma exchange, and immunoabsorption techniques. Using these modalities in conjunction with potent modern immunosuppression, ABO incompatible kidney transplants have achieved graft and patient survivals similar to that seen in ABO compatible transplants. Apheresis has also been an important modality in the removal of anti-human leukocyte antigen (HLA) antibodies both for the purposes of desensitization and treatment of antibody mediated rejection of the kidney. Although good randomized controlled trials are lacking in the treatment of acute antibody mediated rejection, most treatment regimens include the use of apheresis as an essential component for reduction of anti-HLA antibody titers. Similarly, a variety of desensitization protocols have been developed to allow highly sensitized kidney transplant candidates to be successfully transplanted in the presence of donor-specific HLA antibodies. Most of these protocols involve apheresis to improve the removal of pathologic antibodies. Finally, aphereis has been used with mixed success for the treatment of recurrent focal segmental glomerulosclerosis. Evidence indicates that in some cases a circulating factor exists which apheresis can remove and ameliorate the nephrotic proteinuria.

show abstract