Immunoadsorption Combined with Membrane Filtration to Counteract Early Treatment-Refractory Antibody-Mediated Rejection.
Acute antibody-mediated rejection
Immunoadsorption
Kidney transplantation
Membrane filtration
Journal
Blood purification
ISSN: 1421-9735
Titre abrégé: Blood Purif
Pays: Switzerland
ID NLM: 8402040
Informations de publication
Date de publication:
2020
2020
Historique:
received:
10
12
2019
accepted:
13
02
2020
pubmed:
20
3
2020
medline:
7
5
2021
entrez:
20
3
2020
Statut:
ppublish
Résumé
Immunoadsorption (IA) represents a therapeutic option for acute antibody-mediated rejection (ABMR) after kidney transplantation. The addition of membrane filtration (MF) to enhance elimination of macromolecular components that potentially contribute to rejection, such as key complement component C1q and alloreactive IgM, may be an effective strategy to further improve its therapeutic efficiency. Here we present 4 consecutive patients with episodes of HLA donor-specific antibody-positive ABMR nonresponsive to cycles of 6-16 sessions of IA treatment. Rejection episodes were characterized by severe microvascular injury (high-grade microcirculation inflammation and/or signs of thrombotic microangiopathy) and evidence of intense complement activation in peritubular capillaries (diffuse C4d-positivity). IA combined with MF led to substantial morphologic improvement (follow-up biopsies: g + ptc and C4d scores ≤1) and stabilization of allograft function. Our findings provide evidence for an effect of combination of IA + MF in refractory early acute/active ABMR in kidney transplant recipients.
Identifiants
pubmed: 32191942
pii: 000506504
doi: 10.1159/000506504
doi:
Substances chimiques
Isoantibodies
0
Types de publication
Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
576-585Informations de copyright
© 2020 S. Karger AG, Basel.