Background

Chronic active antibody mediated rejection (c-aABMR) leads to progressive decline in allograft function and is a major contributor to long-term kidney allograft loss. To date, there is no effective treatment. At our center patients with c-aABMR are treated with intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP). We conducted a retrospective analysis of these patients to establish efficacy of this treatment.

Methods

We included all patients with biopsy proven c-aABMR treated with IVIG-MP between 2005-2017. Patients were administered three doses of 1g intravenous MP combined with a single dose of IVIG (1g/kg body weight). Additionally, a historic control group who received no treatment was analyzed.

Primary outcome was the decline in allograft function (estimated glomerular filtration rate, eGFR) at one year post treatment. The projected eGFR at 1 year after treatment was calculated based on the progressive decline in eGFR before treatment. Patients with a superior eGFR one year after treatment than the projected eGFR were classified as responder.

Results

A total of 69 patients were treated with IVIG-MP. On average patients showed a decline in eGFR of 9.8 ml/min/1.73m² the year prior to treatment. Following treatment a significant reduction (p<0.001) in eGFR decline was observed (eGFR decline 1 year post treatment: 6.3 ml/min/1.73m²). The historic control group showed no significant change in eGFR the year after diagnosis. Additionally, a significant improvement in proteinuria was observed upon treatment (p<0.001). On average proteinuria increased with 154 mg/mmol the year prior to treatment but showed a decline of 39 mg/mmol the year after.

Forty-one patients were considered responders (59%). Responders showed an average decline of 10.3 ml/min/1.72m² prior to treatment and a near stabilization of graft function in the year after treatment (eGFR decline 1 year post treatment: 1.9 ml/min/1.73m²) (p<0.001). Three and 5-year graft survival was significantly better in responders (82%; 82%) compared to those who did not responder (62%; 33%) and patients not treated for c-aABMR (43%; 43%).

Conclusions

More than half of c-aABMR patients with a progressive decline in eGFR respond favorably to treatment with IVIG-MP leading to a significant improvement of graft survival.

CITATION INFORMATION: Sablik K., Clahsen-van Groningen M., Looman C., Damman J., van Agteren M., Betjes M. Intravenous Immunoglobulins and Methylprednisolone Stabilizes Renal Allograft Function in the Majority of Patients with C-aABMR Am J Transplant. 2017;17 (suppl 3).

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