IVIG and High Dose Steroid Treatment of Transplant Glomerulopathy Effectively Slows Progression of Loss of Renal Allograft Function.
1Nephrology and Transplantation, Erasmus MC University Center, Rotterdam, Netherlands
2Biostatistics, Erasmus MC University Center, Rotterdam, Netherlands
3Pathology, Erasmus MC University Center, Rotterdam, Netherlands
4Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands.
Meeting: 2016 American Transplant Congress
Abstract number: C33
Keywords: Antibodies, Graft function, Immunosuppression, Kidney transplantation
Session Information
Session Name: Poster Session C: Antibody Mediated Rejection: Session #1
Session Type: Poster Session
Date: Monday, June 13, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction
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.
Methods
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.
Results
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).
Conclusions
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, Groningen MClahsen-van, Damman J, Roelen D, Agteren Mvan, 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). https://atcmeetingabstracts.com/abstract/ivig-and-high-dose-steroid-treatment-of-transplant-glomerulopathy-effectively-slows-progression-of-loss-of-renal-allograft-function/. Accessed May 11, 2025.« Back to 2016 American Transplant Congress