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Cited 16 time in webofscience Cited 18 time in scopus
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Outcomes of combination therapy for chronic antibody-mediated rejection in renal transplantation

Authors
Kim, Myung-GyuKim, Yoon JungKwon, Hyuk YongPark, Hayne ChoKoo, Tai YeonJeong, Jong CheolJeon, Hee JungHan, MiyeunAhn, CurieYang, Jaeseok
Issue Date
Dec-2013
Publisher
WILEY-BLACKWELL
Keywords
bortezomib; chronic antibody-mediated rejection; immunoglobulin; plasmapheresis; rituximab
Citation
NEPHROLOGY, v.18, no.12, pp 820 - 826
Pages
7
Indexed
SCIE
SCOPUS
Journal Title
NEPHROLOGY
Volume
18
Number
12
Start Page
820
End Page
826
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/10077
DOI
10.1111/nep.12157
ISSN
1320-5358
1440-1797
Abstract
AimChronic antibody-mediated rejection (CAMR) in renal transplant patients has poor allograft outcomes. However, treatment strategy has not been established yet. Herein, we present short-term outcomes of combination therapy for CAMR. MethodsWe identified nine patients with CAMR or suspicious CAMR who were treated with antihumoral therapy from 2010 to 2011 and analyzed their medical records retrospectively. ResultsFive patients had CAMR, and four patients had suspicious CAMR. Severe transplant glomerulopathy (TG) was observed in seven patients. The estimated glomerular filtration rate (eGFR) was decreased in all patients before treatment. We used three different treatment regimens: (i) high-dose intravenous immunoglobulin (IVIG) and rituximab; (ii) high-dose IVIG, rituximab, and bortezomib; and (iii) plasmapheresis with low-dose IVIG, rituximab and bortezomib. After treatment with one of these three regimens, graft function improved or stabilized in six patients, whereas three patients showed further deterioration of eGFR. The third regimen suppressed deterioration of renal function in all patients. Most patients showed no progression of proteinuria. Infectious complications due to Pneumocystis jirovecii pneumonia and herpes zoster occurred in two patients. ConclusionCombination therapy for CAMR might be effective, even in patients with relatively late-stage CAMR. Summary at a Glance The short term outcomes of three approaches for chronic antibody mediated rejection, including bortezomib, IVIG and rituximab are presented in this clinical experience.
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Kim, Myung Gyu
Anam Hospital (Department of Nephrology and Hypertension, Anam Hospital)
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