Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients
Background: There is no treatment of choice for the management of acute antibody-mediated rejection (ABMR) in kidney transplant recipients. Plasmapheresis ± intravenous immunoglobulin (IVIg) ± rituximab has been used in different regimens with contradictory results. Objective: To compare three regi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Shiraz University of Medical Sciences
2019-07-01
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| Series: | International Journal of Organ Transplantation Medicine |
| Subjects: | |
| Online Access: | http://www.ijotm.com/ojs/index.php/IJOTM/article/view/523 |
| _version_ | 1831760174168145920 |
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| author | F Ahmadi S Dashti-Khavidaki M R Khatami M Gatmiri F Ahmadi M Mahdavi-Mazdeh M T Najafi Z Foroozanfar A Mahdizadeh S Derafshi |
| author_facet | F Ahmadi S Dashti-Khavidaki M R Khatami M Gatmiri F Ahmadi M Mahdavi-Mazdeh M T Najafi Z Foroozanfar A Mahdizadeh S Derafshi |
| author_sort | F Ahmadi |
| collection | DOAJ |
| description | Background: There is no treatment of choice for the management of acute antibody-mediated rejection (ABMR) in kidney transplant recipients. Plasmapheresis ± intravenous immunoglobulin (IVIg) ± rituximab has been used in different regimens with contradictory results.
Objective: To compare three regimens of acute ABMR management including plasmapheresis + IVIg ± rituximab in two different rituximab regimens.
Methods: In this prospective, observational study kidney transplant recipients with suspicious ABMR were categorized into three groups. Group 1 patients were treated with plasmapheresis + IVIg. Groups 2 and 3 received weekly rituximab at a dosage of 375 mg/m2 for either 4 doses (group 2 or high dose) or 2 doses (group 3 or low dose) in addition to plasmapheresis + IVIg.
Results: 8, 15, and 9 patients were categorized in groups 1, 2, and 3, respectively. There was no difference among the groups in terms of demographic and clinical characteristics of recipients and donors. Although, 1-year graft (37.5%, 60.0%, and 66.7% for groups 1, 2, and 3, respectively; p=0.308) and patients survival (75.0%, 86.7%, and 77.8% for groups 1, 2, and 3, respectively; p=0.730) were not significantly different among studied groups, graft survival was 22%–30% higher in rituximab-treated groups. Estimated glomerular filtration rate at 12th month of follow-up did not differ among groups (56.3±19.6, 57.3±20.6, 48.7±16.1 mL/min/1.73 m2 for groups 1, 2, and 3, respectively; p=0.683). However, kidney function steadily improved over time in rituximab-treated patients.
Conclusion: Adding high or low doses of rituximab to plasmapheresis + IVIg comparably increased graft survival in suspicious acute ABMR kidney recipients and steadily improved kidney function among survived allografts over time. |
| first_indexed | 2024-12-22T03:47:28Z |
| format | Article |
| id | doaj.art-49b0d9b0488e4b7880ad50b11031f97b |
| institution | Directory Open Access Journal |
| issn | 2008-6482 2008-6490 |
| language | English |
| last_indexed | 2024-12-22T03:47:28Z |
| publishDate | 2019-07-01 |
| publisher | Shiraz University of Medical Sciences |
| record_format | Article |
| series | International Journal of Organ Transplantation Medicine |
| spelling | doaj.art-49b0d9b0488e4b7880ad50b11031f97b2022-12-21T18:40:06ZengShiraz University of Medical SciencesInternational Journal of Organ Transplantation Medicine2008-64822008-64902019-07-01103307Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant RecipientsF Ahmadi0S Dashti-Khavidaki1M R Khatami2M Gatmiri3F Ahmadi4M Mahdavi-Mazdeh5M T Najafi6Z Foroozanfar7A Mahdizadeh8S Derafshi9Department of Pharmacotherapy, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, IranDepartment of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; and Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, IranNephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; and Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, IranNephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; and Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, IranNephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; and Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, IranNephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; and Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, IranNephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran; and Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, IranDepartment of Epidemiology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, IranFaculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IranImam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, IranBackground: There is no treatment of choice for the management of acute antibody-mediated rejection (ABMR) in kidney transplant recipients. Plasmapheresis ± intravenous immunoglobulin (IVIg) ± rituximab has been used in different regimens with contradictory results. Objective: To compare three regimens of acute ABMR management including plasmapheresis + IVIg ± rituximab in two different rituximab regimens. Methods: In this prospective, observational study kidney transplant recipients with suspicious ABMR were categorized into three groups. Group 1 patients were treated with plasmapheresis + IVIg. Groups 2 and 3 received weekly rituximab at a dosage of 375 mg/m2 for either 4 doses (group 2 or high dose) or 2 doses (group 3 or low dose) in addition to plasmapheresis + IVIg. Results: 8, 15, and 9 patients were categorized in groups 1, 2, and 3, respectively. There was no difference among the groups in terms of demographic and clinical characteristics of recipients and donors. Although, 1-year graft (37.5%, 60.0%, and 66.7% for groups 1, 2, and 3, respectively; p=0.308) and patients survival (75.0%, 86.7%, and 77.8% for groups 1, 2, and 3, respectively; p=0.730) were not significantly different among studied groups, graft survival was 22%–30% higher in rituximab-treated groups. Estimated glomerular filtration rate at 12th month of follow-up did not differ among groups (56.3±19.6, 57.3±20.6, 48.7±16.1 mL/min/1.73 m2 for groups 1, 2, and 3, respectively; p=0.683). However, kidney function steadily improved over time in rituximab-treated patients. Conclusion: Adding high or low doses of rituximab to plasmapheresis + IVIg comparably increased graft survival in suspicious acute ABMR kidney recipients and steadily improved kidney function among survived allografts over time.http://www.ijotm.com/ojs/index.php/IJOTM/article/view/523Antibody-mediated acute rejectionIntravenous immunoglobulinKidney transplantationPlasmapheresisRituximab |
| spellingShingle | F Ahmadi S Dashti-Khavidaki M R Khatami M Gatmiri F Ahmadi M Mahdavi-Mazdeh M T Najafi Z Foroozanfar A Mahdizadeh S Derafshi Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients International Journal of Organ Transplantation Medicine Antibody-mediated acute rejection Intravenous immunoglobulin Kidney transplantation Plasmapheresis Rituximab |
| title | Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients |
| title_full | Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients |
| title_fullStr | Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients |
| title_full_unstemmed | Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients |
| title_short | Comparing Plasmapheresis plus IVIg with Plasmapheresis plus IVIg plus Rituximab on the Management of Suspicious Antibody-Mediated Acute Rejection in Kidney Transplant Recipients |
| title_sort | comparing plasmapheresis plus ivig with plasmapheresis plus ivig plus rituximab on the management of suspicious antibody mediated acute rejection in kidney transplant recipients |
| topic | Antibody-mediated acute rejection Intravenous immunoglobulin Kidney transplantation Plasmapheresis Rituximab |
| url | http://www.ijotm.com/ojs/index.php/IJOTM/article/view/523 |
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