Back to Search
Start Over
C4d-positive acute humoral renal allograft rejection: rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil.
- Source :
-
Transplantation proceedings [Transplant Proc] 2004 Sep; Vol. 36 (7), pp. 2101-3. - Publication Year :
- 2004
-
Abstract
- Objective: We investigated the efficacy of immunoadsorption (IA) in combination with tacrolimus (FK506) and mycophenolate mofetil (MMF) rescue therapy for C4d-positive acute humoral rejection (AHR) of renal transplants.<br />Methods: Six of 185 cadaveric renal allograft recipients developed AHR at a mean of 4.8 +/- 0.8 days after the operation. C4d deposits were observed in peritubular capillaries (PTC) with accumulation of granulocytes. IA with staphylococcal protein A and FK506-MMF combination therapy were administered.<br />Results: After treatment with IA for 6.3 +/- 1.03 sessions combined with FK506 (0.14 to 0.16 mg.kg(-1).d(-1)) and MMF (1.5 g/d) therapy, renal function recovered in all the patients. The mean duration of treatment to a serum creatinine decrease was 14 +/- 2.9 days. The pre-IA panel reactive antibody reactivity (PRA) peaked at 50.2% +/- 6.1%, and was significantly reduced to 8.3% +/- 2.9% after IA. In four of six patients repeat allograft biopsy revealed a remission of AHR. With a mean follow-up of 18.8 +/- 5.46 months, patient and allograft survival are 100% and renal function remains stable with a mean serum creatinine of 1.2 +/- 0.22 mg/dL.<br />Conclusion: The optimal treatment for alloantibody-mediated AHR remains uncertain. Our findings suggest that a therapeutic approach combining IA and FK506-MMF rescue improves the outcome of AHR.
- Subjects :
- Acute Disease
Adult
Antibody Formation
Antigens, CD immunology
CD4 Antigens immunology
Female
Graft Rejection drug therapy
Graft Rejection therapy
Humans
Immunosuppression Therapy methods
Immunosuppressive Agents therapeutic use
Isoantibodies blood
Isoantibodies immunology
Kidney Transplantation pathology
Male
Middle Aged
Antigens, CD blood
CD4 Antigens blood
Graft Rejection immunology
Immunosorbent Techniques
Kidney Transplantation immunology
Mycophenolic Acid analogs & derivatives
Mycophenolic Acid therapeutic use
Tacrolimus therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0041-1345
- Volume :
- 36
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 15518760
- Full Text :
- https://doi.org/10.1016/j.transproceed.2004.07.071