Cyclophosphamide as a Salvage Therapy for Combined Intravenous Immunoglobulins and Plasmapheresis Refractory Antibody-Mediated Rejection
1Nephrology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
2Pathlogy, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Meeting: 2015 American Transplant Congress
Abstract number: A130
Keywords: HLA antibodies, Kidney transplantation, Rejection
Session Information
Session Name: Poster Session A: Kidney Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Acute antibody-mediated rejection (AMR) poses a significant risk to graft survival. Current or standard treatment (ST) of AMR currently consists of plasmapheresis (PP), intravenous immunoglobulin (IVIg) and polyclonal anti-lymphocyte antibody. Treatment options are limited in patients who do not respond, and can include anti-CD20 antibody as well as splenectomy. We have used pulse cyclophosphamide (CYP) in refractory AMR to reduce neutrophil injury as well as plasma cells, with favourable results.
At KFSH &RC-Jeddah , Referral center of kidney transplant in the western rejoin of Saudia Arabia, From January 2010 to Jan 20014, 11 of 333 kidney transplants developed biopsy-proven AMR treated with ST. Four patients were refractory to ST as defined by persistent high level of DSA and lack of improvement in renal function after 10 days of ST. Salvage therapy-patients received pulse CYP intravenously (500 mg, 1 to 3 doses). Outcomes were compared between patients that responded to ST and those with refractory AMR that received CYP.
CYP was well tolerated with no serious adverse effects. One-year allograft survival was 100% For both ST and CYP groups, Serum creatinine median at 6-month (90.0 ± 22.7 vs. 115.0 ±282.5 ¯o;mol/L), 1-year (83.5 ±25.9 vs. 98.0 ± 277.0 ¯o;mol/L) and 2-years (60.0 ± 0.5 vs. 60.0 ± 22.2), for CYP and ST group respectively were equivalent. As expected with more aggressive AMR, the CYP group had higher donor specific antibody (DSA) at AMR diagnosis and at the start of CYP therapy. However CYP treatment resulted in equivalent albeit detectable levels of class I and class II DSA as compared to non-refractory patients.
These results suggest that CYP, by its potential effects on neutrophil effectors as well as antibody producing plasma cells, may be a useful adjunct therapy for patients with aggressive AMR. Its role in comparison to splenectomy, proteosome inhibition or anti C5a therapy remains to be defined in prospective trials . Future trials will require defined patient populations and criteria for refractory AMR rejection.This outcome Support our previous Abstract Data presented at ATC ,Toronto 2010 in Different population.
To cite this abstract in AMA style:
Habhab W, Dada A, Alwassia M, Baz N, Zabani N, Fahmy A, Malik AAbdul. Cyclophosphamide as a Salvage Therapy for Combined Intravenous Immunoglobulins and Plasmapheresis Refractory Antibody-Mediated Rejection [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/cyclophosphamide-as-a-salvage-therapy-for-combined-intravenous-immunoglobulins-and-plasmapheresis-refractory-antibody-mediated-rejection/. Accessed May 8, 2025.« Back to 2015 American Transplant Congress