Treatment of Active Chronic Antibody-Mediated Rejection with Rituximab, IVIG and Plasma Exchange
1Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Barcelona, Spain
2Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
3Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
4Apheresis Unit, Hemotherapy and Hemostasis, Hospital Clinic de Barcelona, Barcelona, Spain
5Immunology, Hospital Clinic de Barcelona, Barcelona, Spain.
Meeting: 2018 American Transplant Congress
Abstract number: 209
Keywords: Antibodies, Graft survival, Kidney transplantation, Rejection
Session Information
Date: Monday, June 4, 2018
Session Name: Concurrent Session: Kidney Chronic Antibody Mediated Rejection
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 4B
Chronic antibody-mediated rejection (cABMR) and transplant glomerulopathy (TG) are main features associated with long-term graft loss. Despite its clinical significance, the available evidence on treatment of cABMR and TG is scarce.
Methods/Materials. 63 patients with TG (cg≥1) and active cABMR diagnosis (Microvascular injury (g+ptc≥2), between 2006 and 2015 were analyzed retrospectively. 24 patients were treated with Rituximab (RTX) in combination with IVIG and plasma exchange and one only with RTX; the others 39 were not treated or only intensified maintenance immunosuppression. The efficacy and safety of the therapy were analyzed.
Results: Treated patients were younger (43 vs. 53 yrs., p 0.01). Charlson comorbidity index (CCI) was lower in treated patients, but not statistically different. Time on dialysis prior to transplant, glomerular filtrate rate and proteinuria at diagnosis of cABMR were similar in both groups. Acute inflammatory and chronic lesions related to cABMR and TG were similar in both groups (Banff 2013). Only C4d deposition was more frequent in treated patients (p<0.001).
The mean dose of RTX was 985.9±351mg and 79.2% receive two doses. RTX treatment began from 1 to 3 weeks after cABMR diagnosis. Graft survival censoring death was equal in both groups (Log Rank 0.74). At 24 months, 9 and 13 patients lost their grafts in RTX and control, respectively (p=0.68). Glomerular filtrate rate deterioration was similar in both groups. Infections requiring hospitalization within one year after treatment were more frequent in RTX patients, 0.62 vs. 0.25 infections/patients (OR=3.9, p=0.017). A CCI of 3 was associated with higher incidence of infections in the untreated group (p=0.036), but not in the treated patients (p=0.14).
RTX therapy, alone or in combination with IVIG and PE, was not effective in treatment of active cABMR with TG and was associated with an important increase in serious infectious complications.
CITATION INFORMATION: Piñeiro G., Rovira J., De Sousa-Amorim E., Villarreal J., Sole M., Revuelta I., Lozano M., Palou E., Oppenheimer F., Campistol J., Diekmann F. Treatment of Active Chronic Antibody-Mediated Rejection with Rituximab, IVIG and Plasma Exchange Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Piñeiro G, Rovira J, Sousa-Amorim EDe, Villarreal J, Sole M, Revuelta I, Lozano M, Palou E, Oppenheimer F, Campistol J, Diekmann F. Treatment of Active Chronic Antibody-Mediated Rejection with Rituximab, IVIG and Plasma Exchange [abstract]. https://atcmeetingabstracts.com/abstract/treatment-of-active-chronic-antibody-mediated-rejection-with-rituximab-ivig-and-plasma-exchange/. Accessed January 24, 2020.« Back to 2018 American Transplant Congress