Background: Chronic antibody-mediated rejection (CAMR) is an important cause of late allograft dysfunction. But established treatment guidelines for CAMR have not been determined. The aim of the current study was to evaluate the efficacy of the protocol composed of rituximab and intravenous immunoglobulin for the treatment of CAMR.
Method: A total of 18 patients diagnosed as CAMR by allograft biopsy were included in this study. We used protocol composed of a single dose of rituximab (RTX, 375mg/m2), followed by intravenous immunoglobulin (IVIg, 0.4 g/kg) for 4 days. The patients were divided into two group, responder (patients with improved or stabilized eGFR after the treatment) and non-responder (patients with deteriorated kidney graft function regardless of the treatment). Serum creatinine, estimated GFR (MDRD equation) and proteinuria was used to determine the efficacy of RTX/IVIg therapy.
Result: All patients showed progressive deterioration of allograft function before RTX/IVIg therapy for CAMR and serum creatinine level was 2.14±0.79 Μmol/L at the diagnosis of CAMR. Ten out of eighteen patients showed donor-specific anti-HLA antibody. Mean survival time of allograft after treatment was 9.30±8.46 months. During 1 year of follow up, decline of eGFR slowed down significantly (P=0.028 [change of eGFR: Pre-RTX -10.94 ± 1.44 vs Post-RTX -3.33 ± 2.49 ml/min/1.73 m2]), however proteinuria did not improve after treatment in most patients (P=0.087 [change of proteinuria: Pre-RTX 1.09 ± 0.47 vs Post-RTX -0.11 ± 0.46 g/day]). In 11 patients belong to responder group, allograft function was stabilized (P=0.347 [40.7 to 43.0 ml/min/1.73 m2]), but showed deteriorated significantly in seven patients classified into non-responder group (P=0.024 [27.8 to 17.1 ml/min/1.73 m2]). Non-responder group showed heavier proteinuria (P = 0.04), more severe peritubular capillaritis (P = 0.027) and higher rate of previous acute rejection episodes (P = 0.028) compared to the responder group.
Conclusion: The combination of RTx and IVIg was effective for the delay of deterioration in CAMR, however the effect was limited in cases with massive proteinuria, more severe PTCs and previous acute rejection.
To cite this abstract in AMA style:An G, Chung B, Park C, Choi B, Kim Y, Yang C. Effectiveness of Rituximab and Intravenous Immunoglobulin for the Treatment of Chronic Antibody Mediated Rejection in Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/effectiveness-of-rituximab-and-intravenous-immunoglobulin-for-the-treatment-of-chronic-antibody-mediated-rejection-in-kidney-transplant-recipients/. Accessed March 31, 2020.
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