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Intravenous Immunoglobulin and Plasmapheresis in Acute Humoral Rejection: Experience in Renal Allograft Transplantation

Lehrich, Ruediger W. ; Rocha, Paulo N. ; Reinsmoen, Nancy ; Greenberg, Arthur ; Butterly, David W. ; Howell, David N. ; Smith, Stephen R.

Human immunology, 2005-04, Vol.66 (4), p.350-358 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
Intravenous Immunoglobulin and Plasmapheresis in Acute Humoral Rejection: Experience in Renal Allograft Transplantation
Autor: Lehrich, Ruediger W. ; Rocha, Paulo N. ; Reinsmoen, Nancy ; Greenberg, Arthur ; Butterly, David W. ; Howell, David N. ; Smith, Stephen R.
Assuntos: Acute Disease ; acute humoral rejection ; Adult ; allograft survival ; Female ; Follow-Up Studies ; Graft Rejection - epidemiology ; Graft Rejection - immunology ; Graft Rejection - therapy ; Graft Survival - immunology ; Humans ; Immunoglobulins, Intravenous - administration & dosage ; Incidence ; intravenous immunoglobulin ; Isoantibodies - adverse effects ; Isoantibodies - biosynthesis ; Kidney Transplantation - immunology ; Male ; Middle Aged ; Pancreas Transplantation - immunology ; Plasmapheresis ; renal allografts ; Retrospective Studies ; Transplantation, Homologous - immunology ; Treatment Outcome
É parte de: Human immunology, 2005-04, Vol.66 (4), p.350-358
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Descrição: Acute humoral rejection (AHR) in kidney transplantation is associated with higher rates of allograft loss when compared with acute cellular rejection (ACR). Treatment with intravenous immunoglobulin (IVIG) combined with plasmapheresis (PP) has been used recently in many centers. We report the incidence, clinical characteristics, and outcome of patients with AHR treated with IVIG and PP. All patients ( n = 519) at our institution who underwent kidney transplantation between January 1999 and August 2003 were retrospectively analyzed and classified according to biopsy results into three groups: AHR, ACR, and no rejection. AHR was diagnosed in 23 patients (4.5%) and ACR in 75 patients (15%). Mean follow-up was 844 ± 23 days. Female sex, black race, and high panel-reactive antibody were risk factors for AHR. Most AHR patients (22 of 23) were treated with IVIG and PP. Two-year graft survival was numerically worse in patients with AHR versus ACR (78% vs. 85%, p = 0.5) but the difference was not statistically significant. Graft survival after AHR treated with IVIG and PP is much better than it has been historically. IVIG in combination with PP is an effective treatment for AHR. Graft survival in this setting is similar to graft survival in patients with ACR.
Editor: United States: Elsevier Inc
Idioma: Inglês

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Intravenous Immunoglobulin and Plasmapheresis in Acute Humoral Rejection: Experience in Renal Allograft Transplantation

Lehrich, Ruediger W. ; Rocha, Paulo N. ; Reinsmoen, Nancy ; Greenberg, Arthur ; Butterly, David W. ; Howell, David N. ; Smith, Stephen R.

United States: Elsevier Inc

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