Therapeutic efficacy of plasmapheresis and intravenous immunoglobulin plus Rituximab for antibody-mediated rejection after kidney transplantation
10.3760/cma.j.issn.0254-1785.2019.08.005
- VernacularTitle:血浆置换和IVIG联合利妥昔单抗治疗肾移植术后AMR的效果分析
- Author:
Lixiang ZHAO
1
;
Zhaoru HUANG
;
Jinfeng LI
;
Lei LIU
;
Keke ZHANG
;
Hongchang XIE
;
Yonghua FENG
;
Xinlu PANG
;
Guiwen FENG
;
Wenjun SHANG
Author Information
1. 郑州大学第一附属医院肾移植科
- Keywords:
Kidney transplantation;
Antibody-mediated rejection;
Plasmapheresis;
Intravenous immunoglobulin;
Rituximab
- From:
Chinese Journal of Organ Transplantation
2019;40(8):468-472
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the therapeutic efficacy of plasmapheresis (PP ) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation .Methods From May 2015 to November 2018 ,a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation .According to the criteria of diagnosing AMR and patient selection ,20 patients were selected for PP+IVIG (group A ,n=12) ,PP+ IVIG+ Rituximab (group B ,n=8) .The efficacies and outcomes of two groups were compared .Results During a follow-up period of (12 .0 ± 5 .8 ) months ,no significant inter-group differences existed in basic profiles (P> 0 .05) .After AMR treatment ,serum creatinine levels decreased significantly from 283 .4 to 226 .4 μmol/L in group A (P=0 .001) and from 289 .4 to 166 .6 μmol/L in group B (P=0 .049) .And the magnitude of decline was more marked in group B (P=0 .023) .Meanwhile ,antibody MFI (log10) decreased from 3 .73 to 3 .62 in group A (P=0 .012) and from 3 .57 to 3 .02 in group B (P=0 .043) .At months 3 and 6 , serum creatinine level was lower in group B than that in group A (125 .0 vs .166 .1 μmol/L , P=0 .03 ;127 .0 vs .169 .0μmol/L ,P=0 .048) .The serum creatinine levels of AMR patients were 249 .8 and 233 .8 μmol/L respectively ( P= 0 .182 ) .Serum creatinine levels were 176 .1 and 120 .3 μmol/L ( P=0 .045) and 180 .2 and 114 .8 μmol/L at months 3 and 6 (P=0 .044) respectively .Serum creatinine levels were 202 .8 and 122 .5μmol/L (P=0 .049) in group A and 142 .7 and 107 .0μmol/L (P=0 .046) in group B respectively .Four recipients developed allograft failure .At month 6 post-operation ,AMR occurred in group A (n=3 ,25％ ) and group B (n=1 ,12 .5％ ) .And the incidence of leucopenia was 37 .5％ and 0 (P=0 .049) in groups A and B respectively .Conclusions PP and IVIG plus rituximab is more efficacious for AMR .The earlier occurring time ,the better prognosis .
