Journal de néphrologie et thérapeutique

Chronic Antibody Mediated Rejection of Renal Allograft - Efficacy of Combined Treatment with Plasma Exchanges, Intravenous Immunoglobulin and Rituximab (One Center Experience)

Abstract

Stolyarevich ES ,Artyukhina LA ,Elena Zakharova *,Tomilina NA

Chronic antibody mediated rejection (CAMR) is the main cause for late kidney transplant loss, and the results of its treatment are dissatisfying. In our one center study we evaluated the efficacy of combined treatment with plasma exchanges, intravenous immunoglobulin and rituximab on the top of standard immunosuppression in 24 patients with chronic transplant glomerulopathy (TG), compared to control group of 26 patients, who did not receive additional treatment. At the time of diagnosis baseline estimated glomerular filtration rate (eGFR) did not differ between treatment and control subgroups (44.9 ± 21.3 vs 41.2 ± 14.6 ml/min, P = 0.47), as well as any other laboratory or pathology data, and subsequent decline of allograft function was also found in both subgroups. However, the rate of eGFR decline was significantly lower in the patients from the treatment subgroup compared to the controls: -0.47 ± 0.6 ml/min/month and -1.31 ± 1.6 ml/min/month respectively (P = 0.02). Thus 3-year transplant survival turned to be 21.3% in the control subgroup vs 64.8% in the treatment subgroup (p = 0.01). Our study demonstrated, that TG, which is the most often variant of CAMR, is characterized by unfavorable prognosis regardless of its pathology features and activity at the time of diagnosis. Combined treatment, including plasma exchanges (PE), intravenous immunoglobulin (IVIG) and rituximab (Rtx) allows slowing down the rate of the disease progression at least in some proportion of patients with lately diagnosed CAMR.