Lixiang Zhao, Z. Huang, Jinfeng Li, Lei Liu, Keke Zhang, Hongchang Xie, Yong-hua Feng, X. Pang, G. Feng
{"title":"血浆置换联合静脉注射免疫球蛋白联合利妥昔单抗治疗肾移植后抗体介导性排斥反应的疗效观察","authors":"Lixiang Zhao, Z. Huang, Jinfeng Li, Lei Liu, Keke Zhang, Hongchang Xie, Yong-hua Feng, X. Pang, G. Feng","doi":"10.3760/CMA.J.ISSN.0254-1785.2019.08.005","DOIUrl":null,"url":null,"abstract":"Objective \nTo compare the therapeutic efficacy of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation. \n \n \nMethods \nFrom May 2015 to November 2018, a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation. According to the criteria of diagnosing AMR and patient selection, 20 patients were selected for PP+ IVIG (group A, n=12), PP+ IVIG+ Rituximab (group B, n=8). The efficacies and outcomes of two groups were compared. \n \n \nResults \nDuring a follow-up period of (12.0±5.8) months, no significant inter-group differences existed in basic profiles (P>0.05). After AMR treatment, serum creatinine levels decreased significantly from 283.4 to 226.4 μmol/L in group A (P=0.001) and from 289.4 to 166.6 μmol/L in group B (P=0.049). And the magnitude of decline was more marked in group B (P=0.023). Meanwhile, antibody MFI (log10) decreased from 3.73 to 3.62 in group A (P=0.012) and from 3.57 to 3.02 in group B (P=0.043). At months 3 and 6, serum creatinine level was lower in group B than that in group A (125.0 vs. 166.1 μmol/L, P=0.03; 127.0 vs. 169.0 μmol/L, P=0.048). The serum creatinine levels of AMR patients were 249.8 and 233.8 μmol/L respectively (P=0.182). Serum creatinine levels were 176.1 and 120.3 μmol/L (P=0.045) and 180.2 and 114.8 μmol/L at months 3 and 6 (P=0.044) respectively. Serum creatinine levels were 202.8 and 122.5 μmol/L (P=0.049) in group A and 142.7 and 107.0 μmol/L (P=0.046) in group B respectively. Four recipients developed allograft failure. At month 6 post-operation, AMR occurred in group A (n=3, 25%) and group B (n=1, 12.5%). And the incidence of leucopenia was 37.5% and 0 (P=0.049) in groups A and B respectively. \n \n \nConclusions \nPP and IVIG plus rituximab is more efficacious for AMR. The earlier occurring time, the better prognosis. \n \n \nKey words: \nKidney transplantation; Antibody-mediated rejection; Plasmapheresis; Intravenous immunoglobulin; Rituximab","PeriodicalId":9885,"journal":{"name":"Chineae Journal of Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Therapeutic efficacy of plasmapheresis and intravenous immunoglobulin plus Rituximab for antibody-mediated rejection after kidney transplantation\",\"authors\":\"Lixiang Zhao, Z. Huang, Jinfeng Li, Lei Liu, Keke Zhang, Hongchang Xie, Yong-hua Feng, X. Pang, G. Feng\",\"doi\":\"10.3760/CMA.J.ISSN.0254-1785.2019.08.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective \\nTo compare the therapeutic efficacy of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation. \\n \\n \\nMethods \\nFrom May 2015 to November 2018, a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation. According to the criteria of diagnosing AMR and patient selection, 20 patients were selected for PP+ IVIG (group A, n=12), PP+ IVIG+ Rituximab (group B, n=8). The efficacies and outcomes of two groups were compared. \\n \\n \\nResults \\nDuring a follow-up period of (12.0±5.8) months, no significant inter-group differences existed in basic profiles (P>0.05). After AMR treatment, serum creatinine levels decreased significantly from 283.4 to 226.4 μmol/L in group A (P=0.001) and from 289.4 to 166.6 μmol/L in group B (P=0.049). And the magnitude of decline was more marked in group B (P=0.023). Meanwhile, antibody MFI (log10) decreased from 3.73 to 3.62 in group A (P=0.012) and from 3.57 to 3.02 in group B (P=0.043). At months 3 and 6, serum creatinine level was lower in group B than that in group A (125.0 vs. 166.1 μmol/L, P=0.03; 127.0 vs. 169.0 μmol/L, P=0.048). The serum creatinine levels of AMR patients were 249.8 and 233.8 μmol/L respectively (P=0.182). Serum creatinine levels were 176.1 and 120.3 μmol/L (P=0.045) and 180.2 and 114.8 μmol/L at months 3 and 6 (P=0.044) respectively. Serum creatinine levels were 202.8 and 122.5 μmol/L (P=0.049) in group A and 142.7 and 107.0 μmol/L (P=0.046) in group B respectively. Four recipients developed allograft failure. At month 6 post-operation, AMR occurred in group A (n=3, 25%) and group B (n=1, 12.5%). And the incidence of leucopenia was 37.5% and 0 (P=0.049) in groups A and B respectively. \\n \\n \\nConclusions \\nPP and IVIG plus rituximab is more efficacious for AMR. The earlier occurring time, the better prognosis. \\n \\n \\nKey words: \\nKidney transplantation; Antibody-mediated rejection; Plasmapheresis; Intravenous immunoglobulin; Rituximab\",\"PeriodicalId\":9885,\"journal\":{\"name\":\"Chineae Journal of Organ Transplantation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-08-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chineae Journal of Organ Transplantation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.005\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chineae Journal of Organ Transplantation","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3760/CMA.J.ISSN.0254-1785.2019.08.005","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Therapeutic efficacy of plasmapheresis and intravenous immunoglobulin plus Rituximab for antibody-mediated rejection after kidney transplantation
Objective
To compare the therapeutic efficacy of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation.
Methods
From May 2015 to November 2018, a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation. According to the criteria of diagnosing AMR and patient selection, 20 patients were selected for PP+ IVIG (group A, n=12), PP+ IVIG+ Rituximab (group B, n=8). The efficacies and outcomes of two groups were compared.
Results
During a follow-up period of (12.0±5.8) months, no significant inter-group differences existed in basic profiles (P>0.05). After AMR treatment, serum creatinine levels decreased significantly from 283.4 to 226.4 μmol/L in group A (P=0.001) and from 289.4 to 166.6 μmol/L in group B (P=0.049). And the magnitude of decline was more marked in group B (P=0.023). Meanwhile, antibody MFI (log10) decreased from 3.73 to 3.62 in group A (P=0.012) and from 3.57 to 3.02 in group B (P=0.043). At months 3 and 6, serum creatinine level was lower in group B than that in group A (125.0 vs. 166.1 μmol/L, P=0.03; 127.0 vs. 169.0 μmol/L, P=0.048). The serum creatinine levels of AMR patients were 249.8 and 233.8 μmol/L respectively (P=0.182). Serum creatinine levels were 176.1 and 120.3 μmol/L (P=0.045) and 180.2 and 114.8 μmol/L at months 3 and 6 (P=0.044) respectively. Serum creatinine levels were 202.8 and 122.5 μmol/L (P=0.049) in group A and 142.7 and 107.0 μmol/L (P=0.046) in group B respectively. Four recipients developed allograft failure. At month 6 post-operation, AMR occurred in group A (n=3, 25%) and group B (n=1, 12.5%). And the incidence of leucopenia was 37.5% and 0 (P=0.049) in groups A and B respectively.
Conclusions
PP and IVIG plus rituximab is more efficacious for AMR. The earlier occurring time, the better prognosis.
Key words:
Kidney transplantation; Antibody-mediated rejection; Plasmapheresis; Intravenous immunoglobulin; Rituximab
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