Diagnosis and Treatment of Acute Humoral Kidney Allograft Rejection

Abstract Acute humoral rejection (AHR) is a severe form of rejection associated with poor graft survival. Prompt diagnosis and rapid institution of therapy are crucial to improve the prognosis. A therapeutic approach based on plasmapheresis, intravenous imunoglobulin, and rituximab seems to be effec...

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Bibliographic Details
Published in:Transplantation proceedings 2009-04, Vol.41 (3), p.855-858
Main Authors: Gomes, A.M, Pedroso, S, Martins, L.S, Malheiro, J, Viscayno, J.R, Santos, J, Dias, L, Henriques, A.C, Sarmento, A.M, Cabrita, A
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Antibody Formation
Biological and medical sciences
Biopsy
Creatinine - blood
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Graft Rejection - diagnosis
Graft Rejection - therapy
Humans
Immunoglobulins, Intravenous - therapeutic use
Kidney Diseases - surgery
Kidney Transplantation - immunology
Kidney Transplantation - pathology
Kidney Transplantation - physiology
Male
Medical sciences
Middle Aged
Plasmapheresis
Renal Replacement Therapy
Retrospective Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Tissue, organ and graft immunology
Transplantation, Homologous - immunology
Transplantation, Homologous - pathology
Young Adult
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Summary:Abstract Acute humoral rejection (AHR) is a severe form of rejection associated with poor graft survival. Prompt diagnosis and rapid institution of therapy are crucial to improve the prognosis. A therapeutic approach based on plasmapheresis, intravenous imunoglobulin, and rituximab seems to be effective in refractory cases. Herein we have described our experience with 11 patients with biopsy-proven AHR who were treated between January 2005 and June 2008. Seven of these patients had panel reactive antibodies titers more than 50%. The diagnosis was based on Banff 2001 criteria; treatment consisted of a combination of plasmapheresis and intravenous immunoglobulin. Four refractory cases were also treated with a single dose of rituximab. One graft was lost due to thrombosis. All other patients recovered graft function with an average creatinine level of 1.6 mg/dL at 8.6 ± 2.7 months of follow-up.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2009.01.062