1. Rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil for C4d-positive acute humoral renal allograft rejection.
- Author
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Ji SM, Liu ZH, Chen JS, Sha GZ, Ji DX, and Li LS
- Subjects
- Acute Disease, Adult, Female, Graft Rejection drug therapy, Graft Rejection immunology, HLA Antigens analysis, Humans, Kidney Transplantation pathology, Male, Middle Aged, Mycophenolic Acid therapeutic use, Reoperation statistics & numerical data, Transplantation, Homologous, Antibody Formation, Complement C4b analysis, Graft Rejection therapy, Immunosorbent Techniques, Kidney Transplantation immunology, Mycophenolic Acid analogs & derivatives, Peptide Fragments analysis, Tacrolimus therapeutic use
- Abstract
The aim of this study was to investigate the efficacy of immunoadsorption (IA) in combination with tacrolimus (TAC; 0.14 to 0.16 mg/kg/d) and mycophenolate mofetil (MMF; 1.5 to 2.0 g/d) rescue therapy for C4d-positive acute humoral rejection in nine cadaveric renal allograft recipients. Initial Panel reactive antibody (PRA-I and PRA-II levels were as high as 28.8% +/- 16.2% and 15.3% +/- 8.9%, IA therapy significantly decreased PRA-I and PRA-II levels to 5.9% +/- 2.9% and 2.2% +/- 0.6%, respectively. Total serum immunoglobulin levels were markedly decreased. Repeated allograft renal biopsy in nine patients revealed remission of acute humoral rejection (AHR), and the deposition of C4d disappeared and reduced. With a mean follow-up of 29.4 +/- 5.4 months, patient and allograft survivals were 100%, and renal function remained stable with a mean serum creatinine of 1.1 +/- 0.3 mg/dL. Our findings suggested that a therapeutic approach combining IA and TAC and MMF rescue improved the outcomes of AHR.
- Published
- 2006
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