Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection

Abstract Background Chronic-active antibody mediated rejection (c-aABMR) is a major contributor to long-term kidney allograft loss. We conducted a retrospective analysis to establish the efficacy of treatment with intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP) of patients with...

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Main Authors: Kasia A. Sablik, Marian C. Clahsen-van Groningen, Caspar W. N. Looman, Jeffrey Damman, Madelon van Agteren, Michiel G. H. Betjes
Format: Article
Language:English
Published: BMC 2019-06-01
Series:BMC Nephrology
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12882-019-1385-z
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author Kasia A. Sablik
Marian C. Clahsen-van Groningen
Caspar W. N. Looman
Jeffrey Damman
Madelon van Agteren
Michiel G. H. Betjes
author_facet Kasia A. Sablik
Marian C. Clahsen-van Groningen
Caspar W. N. Looman
Jeffrey Damman
Madelon van Agteren
Michiel G. H. Betjes
author_sort Kasia A. Sablik
collection DOAJ
description Abstract Background Chronic-active antibody mediated rejection (c-aABMR) is a major contributor to long-term kidney allograft loss. We conducted a retrospective analysis to establish the efficacy of treatment with intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP) of patients with c-aABMR. Methods Sixty-nine patients, in the period 2005–2017, with the diagnosis (suspicious for) c-aABMR that were treated with IVIG and MP were included. Patients were administered three doses of 1 g intravenous MP combined with a single dose of IVIG (1 g/kg body weight). Primary outcome was the decline in allograft function one year post treatment. Responders to IVIG-MP therapy were defined by an eGFR one year after treatment which was at least 25% above the projected allograft function. Results Patients showed an average decline in eGFR of 9.8 ml/min/1.73m2 the year prior to treatment. Following treatment, a significant reduction (p < 0.001) in eGFR decline was observed (6.3 ml/min/1.73m2). Furthermore, a significant improvement in proteinuria was observed upon treatment (p < 0.001). Sixty-two percent (n = 43) of the patients were considered a responder and showed considerable slowing of graft function deterioration in the year after treatment (p < 0.001). Three and 5-year graft survival was significantly superior in responders. Conclusions More than 60% of patients with c-aABMR with a progressive decline in eGFR respond favorably to treatment with IVIG-MP resulting in a significant improvement of graft survival (Sablik, Am J Transplant 18, 2018).
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spelling doaj.art-7410a0f845f442bf84a515355d5e7a132022-12-21T17:58:39ZengBMCBMC Nephrology1471-23692019-06-012011910.1186/s12882-019-1385-zTreatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejectionKasia A. Sablik0Marian C. Clahsen-van Groningen1Caspar W. N. Looman2Jeffrey Damman3Madelon van Agteren4Michiel G. H. Betjes5Erasmus Medical Center, Department of Nephrology & Transplantation, room Na2105Department of Pathology, Erasmus Medical CenterDepartment of Biostatistics, Erasmus Medical CenterDepartment of Pathology, Erasmus Medical CenterErasmus Medical Center, Department of Nephrology & Transplantation, room Na2105Erasmus Medical Center, Department of Nephrology & Transplantation, room Na2105Abstract Background Chronic-active antibody mediated rejection (c-aABMR) is a major contributor to long-term kidney allograft loss. We conducted a retrospective analysis to establish the efficacy of treatment with intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP) of patients with c-aABMR. Methods Sixty-nine patients, in the period 2005–2017, with the diagnosis (suspicious for) c-aABMR that were treated with IVIG and MP were included. Patients were administered three doses of 1 g intravenous MP combined with a single dose of IVIG (1 g/kg body weight). Primary outcome was the decline in allograft function one year post treatment. Responders to IVIG-MP therapy were defined by an eGFR one year after treatment which was at least 25% above the projected allograft function. Results Patients showed an average decline in eGFR of 9.8 ml/min/1.73m2 the year prior to treatment. Following treatment, a significant reduction (p < 0.001) in eGFR decline was observed (6.3 ml/min/1.73m2). Furthermore, a significant improvement in proteinuria was observed upon treatment (p < 0.001). Sixty-two percent (n = 43) of the patients were considered a responder and showed considerable slowing of graft function deterioration in the year after treatment (p < 0.001). Three and 5-year graft survival was significantly superior in responders. Conclusions More than 60% of patients with c-aABMR with a progressive decline in eGFR respond favorably to treatment with IVIG-MP resulting in a significant improvement of graft survival (Sablik, Am J Transplant 18, 2018).http://link.springer.com/article/10.1186/s12882-019-1385-zTransplantationRenal allograft rejectionC-aABMRIVIGMPTreatment
spellingShingle Kasia A. Sablik
Marian C. Clahsen-van Groningen
Caspar W. N. Looman
Jeffrey Damman
Madelon van Agteren
Michiel G. H. Betjes
Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection
BMC Nephrology
Transplantation
Renal allograft rejection
C-aABMR
IVIG
MP
Treatment
title Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection
title_full Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection
title_fullStr Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection
title_full_unstemmed Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection
title_short Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection
title_sort treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic active antibody mediated rejection
topic Transplantation
Renal allograft rejection
C-aABMR
IVIG
MP
Treatment
url http://link.springer.com/article/10.1186/s12882-019-1385-z
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