The antibody-mediated rejection (AMR) has become clinically critical because this form of rejection is usually unresponsive to conventional anti-rejection therapy. Therefore, it has been recognized as a major cause of allograft loss. Several treatment protocols exist but none of them are efficacious or standardized. The aim of the present work was to assess the effectiveness of a treatment consisting of plasmapheresis + IVIg+ rituximab in kidney and simultaneous pancreas-kidney (SPK) transplant patients with a biopsy proven sign of AMR. Sixteen transplant patients (11 kidneys and 5 SPK) were included in this study (from January 2010 to January 2015). Biopsies were taken at the time of the suspicious of the rejection. The estimated glomerular filtration rate (MDRD), proteinuria, serum creatinine and histologic scores were assessed at the time of the rejection and one month after treatment with plasmapheresis+IVIg+rituximab. The parameter used to evaluate the clinical functional efficacy of the treatment was increases in MDRD values, of at least a 10% in the first month after treatment. From those 16 patients, we observed that ten patients increased the values of MDRD (42 ± 6 %). There were 6 responders among the kidney transplant patients (55 %) and 4 among the SPK (80 %), with an overall increase in MDRD in 62.5 %. Interestingly, in a univariate analysis, the maintenance treatment with rapamacyn, micophenolate and steroids before rejection was found to be associated with non response to this antirejection treatment (compared to tacrolimus, micophenolate and steroids).

Conclusion: this preliminary study shows that the treatment with plasmapheresis, IVIg and rituximab has an overall increase in MDRD in over 62 % of patients with AMR after kidney and SPK transplantation. This results were more successfull in patients that were on tacrolimus based immunosuppression.

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