Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Transplant glomerulopathy (TG) is commonly associated with chronic antibody mediated rejection and is a major cause of late kidney allograft loss with no established effective therapy. At our center, patients with TG within the context of chronic antibody mediated rejection are treated with intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP). In this study we analysed the efficacy of this treatment.
From 2008 until 2015, 40 patients with biopsy proven TG were treated with IVIG/MP. All patients underwent a renal biopsy because of progressive decline in renal function (eGFR) at least 1 year post transplantation. Biopsies were scored according to the Banff classification.
After biopsy proven TG, patients were administered three doses of 1 g intravenous MP combined with a single dose of IVIG (1 g/kg body weight). The efficacy of the treatment was analysed by comparing the slope of eGFR 12 months prior to treatment to the course of eGFR in the 12 months after treatment by linear multilevel analysis. Clinical and histomorphological parameters were analysed for association with outcome.
Treatment with IVIG/MP resulted in a significant decrease in eGFR gradient from -10.5 ml/min/1.73m2/year pre-treatment to -4.7 ml/min/1.73m2/year post-treatment (P<0.001). Four patients were non-responders returning to dialysis within the first year after treatment. No parameter associated with non-responsiveness could be identified. 30 out of 40 patients reached a 2-year follow up end-point. Data extrapolation showed that in 70% of these patients a beneficial treatment effect is still present.
Additionally, prior to IVIG/MP, proteinuria increased with an average of 0.62 g/L/year and thereafter decreased with 0.11 g/L/year (P=0.003).
IVIG/MP treatment for TG is associated with an average 50% reduction in eGFR loss within the first year after treatment and reduces proteinuria significantly. However, more efficient therapeutic options are needed.
CITATION INFORMATION: Sablik K, Looman C, Clahsen-van Groningen M, Damman J, Roelen D, van Agteren M, Betjes M. IVIG and High Dose Steroid Treatment of Transplant Glomerulopathy Effectively Slows Progression of Loss of Renal Allograft Function. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Sablik K, Looman C, Clahsen-van M, Damman J, Roelen D, van M, Betjes M. IVIG and High Dose Steroid Treatment of Transplant Glomerulopathy Effectively Slows Progression of Loss of Renal Allograft Function. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/ivig-and-high-dose-steroid-treatment-of-transplant-glomerulopathy-effectively-slows-progression-of-loss-of-renal-allograft-function/. Accessed January 20, 2018.
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