scholarly journals Treatment of Chronic Active Antibody-mediated Rejection in Renal Transplant Recipients – A single center retrospective study

2019 ◽  
Author(s):  
Hsien-Fu Chiu ◽  
Mei-Chin Wen ◽  
Ming-Ju Wu ◽  
Cheng-Hsu Chen ◽  
Tung-Min Yu ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Rank Test ◽  
Renal Transplant Recipients ◽  
Supportive Treatment ◽  
Aggressive Treatment ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Group 2 ◽  
Group 1

Abstract Background: Chronic active antibody-mediated rejection is a major etiology of graft loss in renal transplant recipients. However, there are no approved treatments. Methods: Computerized records from Taichung Veterans General Hospital were collected to identify the renal transplant biopsies performed in the past 7 years with the diagnosis of chronic active antibody-mediated rejection. The patients were divided into two groups according to treatment strategy: Group 1: aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2: supportive treatment. Results: From February 2009 to December 2017, a total of 82 patients with biopsy-proven chronic antibody mediated rejection were identified. Kaplan-Meier analysis of death-censored graft survival showed a worse survival in group 2 ( P = 0.015 by log-rank test). Adverse event-free survival was lower in group 1, whereas patient survival was no significant different. Proteinuria and supportive treatment were independent risk factors for graft loss in multivariate analysis. Conclusions : Aggressive treatment was associated with better graft outcome. However, higher incidence of adverse events merit personalized treatment, especially for those with higher risk of infection. Appropriate prophylactic antibiotics are recommended for aggressive treatment patients.

scholarly journals Treatment of chronic active antibody-mediated rejection in renal transplant recipients – a single center retrospective study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hsien-Fu Chiu ◽  
Mei-Chin Wen ◽  
Ming-Ju Wu ◽  
Cheng-Hsu Chen ◽  
Tung-Min Yu ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Rank Test ◽  
Renal Transplant Recipients ◽  
Supportive Treatment ◽  
Aggressive Treatment ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Group 2 ◽  
Group 1

Abstract Background Chronic active antibody-mediated rejection is a major etiology of graft loss in renal transplant recipients. However, there is no consensus on the optimal treatment strategies. Methods Computerized records from Taichung Veterans General Hospital were collected to identify renal transplant biopsies performed in the past 7 years with a diagnosis of chronic active antibody-mediated rejection. The patients were divided into two groups according to treatment strategy: Group 1 received aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2 received supportive treatment. Results From February 2009 to December 2017, a total of 82 patients with biopsy-proven chronic antibody mediated rejection were identified. Kaplan-Meier analysis of death-censored graft survival showed a worse survival in group 2 (P = 0.015 by log-rank test). Adverse event-free survival was lower in group 1, whereas patient survival was not significantly different. Proteinuria and supportive treatment were independent risk factors for graft loss in multivariate analysis. Conclusions Aggressive treatment was associated with better graft outcome. However, higher incidence of adverse events merit personalized treatment, especially for those with higher risk of infection. Appropriate prophylactic antibiotics are recommended for patients undergoing aggressive treatment.

scholarly journals Treatment of Chronic Active Antibody-mediated Rejection in Renal Transplant Recipients – A single center retrospective study

2019 ◽  
Author(s):  
Hsien-Fu Chiu ◽  
Mei-Chin Wen ◽  
Ming-Ju Wu ◽  
Cheng-Hsu Chen ◽  
Tung-Min Yu ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Adverse Events ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Supportive Treatment ◽  
Aggressive Treatment ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Group 2 ◽  
Group 1

Abstract Background: A plethora of evidences suggest that the most important cause of late graft loss in renal transplant recipients is chronic active antibody-mediated rejection. However, there are no consensus on treatment strategies. Methods: We retrospectively analyzed clinical and pathological data of renal transplant recipients who received kidney graft biopsy with confirmed diagnosis of chronic active antibody-mediated rejection in the past 7 years. The patients were divided into two groups according to treatment strategy: Group 1: aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2: supportive treatment. Results: From February 2009 to December 2017, a total of 82 patients with biopsy-proven chronic antibody mediated rejection were identified. Kaplan-Meier analysis of death-censored graft survival showed a worse survival in group 2 ( P = 0.015 by log-rank test). Adverse event-free survival was lower in group 1, whereas patient survival was no significant different. Proteinuria and supportive treatment were independent risk factors for graft loss in multivariate analysis. Conclusions : Aggressive treatment was associated with better graft outcome. However, higher incidence of adverse events merit personalized treatment, especially for those with higher risk of infection. Appropriate prophylactic antibiotics are recommended for aggressive treatment patients. Key words: chronic active antibody mediated rejection, kidney transplantation, graft survival, adverse events

scholarly journals Treatment of Chronic Active Antibody-mediated Rejection in Renal Transplant Recipients – A single center retrospective study

2019 ◽  
Author(s):  
Hsien-Fu Chiu(Former Corresponding Author) ◽  
Mei-Chin Wen ◽  
Ming-Ju Wu ◽  
Cheng-Hsu Chen ◽  
Tung-Min Yu ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Adverse Events ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Supportive Treatment ◽  
Aggressive Treatment ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Group 2 ◽  
Group 1

Abstract Background: A plethora of evidences suggest that the most important cause of late graft loss in renal transplant recipients is chronic active antibody-mediated rejection. However, there are no consensus on treatment strategies. Methods: We retrospectively analyzed clinical and pathological data of renal transplant recipients who received kidney graft biopsy with confirmed diagnosis of chronic active antibody-mediated rejection in the past 7 years. The patients were divided into two groups according to treatment strategy: Group 1: aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2: supportive treatment. Results: From February 2009 to December 2017, a total of 82 patients with biopsy-proven chronic antibody mediated rejection were identified. Kaplan-Meier analysis of death-censored graft survival showed a worse survival in group 2 (P = 0.015 by log-rank test). Adverse event-free survival was lower in group 1, whereas patient survival was no significant different. Proteinuria and supportive treatment were independent risk factors for graft loss in multivariate analysis. Conclusions: Aggressive treatment was associated with better graft outcome. However, higher incidence of adverse events merit personalized treatment, especially for those with higher risk of infection. Appropriate prophylactic antibiotics are recommended for aggressive treatment patients. Key words: chronic active antibody mediated rejection, kidney transplantation, graft survival, adverse events

scholarly journals Treatment of Chronic Active Antibody-mediated Rejection in Renal Transplant Recipients – A single center retrospective study

2019 ◽  
Author(s):  
Hsien-Fu Chiu ◽  
Mei-Chin Wen ◽  
Ming-Ju Wu ◽  
Cheng-Hsu Chen ◽  
Tung-Min Yu ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Kidney Graft ◽  
Supportive Treatment ◽  
Aggressive Treatment ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Group 2 ◽  
Group 1

Abstract Background: A plethora of evidences suggest that the most important cause of late graft loss in renal transplant recipients is chronic active antibody-mediated rejection. However, there are no consensus on treatment strategies. Methods: We retrospectively analyzed clinical and pathological data of renal transplant recipients who received kidney graft biopsy with confirmed diagnosis of chronic active antibody-mediated rejection in the past 7 years. The patients were divided into two groups according to treatment strategy: Group 1: aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2: supportive treatment. Results: From February 2009 to December 2017, a total of 82 graft biopsies with diagnosis of chronic active antibody mediated rejection were identified. Kaplan-Meier analysis of death-censored graft survival showed a worse survival in group 2 (P = 0.015 by log-rank test). Adverse event-free survival was lower in group 1, whereas patient survival was no significant different. Proteinuria and supportive treatment were independent risk factors for graft loss in multivariate analysis. Conclusions: Aggressive treatment was associated with better graft outcome. However, higher incidence of adverse events merit personalized treatment, especially for those with higher risk of infection. Appropriate prophylactic antibiotics are recommended for aggressive treatment patients.

scholarly journals Flow Cytometric Crossmatching in Primary Renal Transplant Recipients with a Negative Anti-Human Globulin Enhanced Cytotoxicity Crossmatch

2001 ◽  
Vol 12 (12) ◽  
pp. 2807-2814 ◽  
Author(s):  
Martin Karpinski ◽  
David Rush ◽  
John Jeffery ◽  
Markus Exner ◽  
Heinz Regele ◽  
...  
Keyword(s):  
T Cell ◽  
Renal Transplant ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Flow Cytometric ◽  
Increased Risk ◽  
Early Graft

ABSTRACT. Flow cytometric crossmatching (FCXM) and panel reactive antibody (PRA) screening techniques are more sensitive than anti-human globulin enhanced cytotoxicity (AHG-CDC) techniques at detecting anti-HLA antibodies. The clinical significance of a positive FCXM in primary renal transplant recipients with a negative AHG-CDC crossmatch is unclear. We performed retrospective FCXM and flow cytometric panel reactive antibody (FlowPRA) determinations in primary renal transplant recipients with a negative T cell AHG-CDC crossmatch and a negative B cell CDC crossmatch pretransplant. Eighteen (13%) of 143 patients exhibited a positive retrospective T cell FCXM. Of these patients, six (33%) experienced early graft loss with explant histology, demonstrating antibody-mediated rejection in five of six cases. The 12 patients with positive T cell FCXM who maintained their grafts experienced more adverse events posttransplant, including more early, steroid-resistant, and recurrent rejection. Furthermore, in a subgroup of patients undergoing protocol biopsies, those with a positive T cell FCXM exhibited more subclinical rejection. Anti-HLA antibodies were detected by FlowPRA in all 18 patients with a positive T cell FCXM, whereas AHG-CDC PRA detected antibodies in only 8 of 18 patients. Therefore, flow cytometric techniques identify sensitized primary renal transplant recipients undetected by AHG-CDC techniques. In those patients, a positive T cell FCXM is associated with an increased risk of early graft loss due to antibody-mediated rejection and may represent a relative contraindication to transplantation. Moreover, those patients are also at increased risk of severe and recurrent rejection, which may carry implications for long-term graft outcomes.

Early Versus Late Acute Antibody-Mediated Rejection in Renal Transplant Recipients

2013 ◽  
Vol 96 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Christina Dörje ◽  
Karsten Midtvedt ◽  
Hallvard Holdaas ◽  
Christian Naper ◽  
Erik H. Strøm ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection
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