Immunoadsorption in Severe C4d‐Positive Acute Kidney Allograft Rejection: A Randomized Controlled Trial

Antibody‐mediated rejection (AMR) frequently causes refractory graft dysfunction. This randomized controlled trial was designed to evaluate whether immunoadsorption (IA) is effective in the treatment of severe C4d‐positive AMR. Ten out of 756 kidney allograft recipients were included. Patients were randomly assigned to IA with protein A (N = 5) or no such treatment (N = 5) with the option of IA rescue after 3 weeks. Enrolled recipients were subjected to tacrolimus conversion and, if indicated, ‘anti‐cellular’ treatment. All IA‐treated patients responded to treatment. One death unrelated to IA occurred after successful reversal of rejection. Four control subjects remained dialysis‐dependent. With the exception of one patient who developed graft necrosis, non‐responders were subjected to rescue IA, however, without success. Because of a high graft loss rate in the control group the study was terminated after a first interim analysis. Even though limited by small patient numbers, this trial suggests efficiency of IA in reversing severe AMR.

[1]  A. Magil,et al.  Focal peritubular capillary C4d deposition in acute rejection. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[2]  Zhi-Hong Liu,et al.  Tacrolimus combined with mycophenolate mofetil can effectively reverse C4d-positive steroid-resistant acute rejection in Chinese renal allograft recipients. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[3]  W. Druml,et al.  Peritransplant Immunoadsorption: A Strategy Enabling Transplantation in Highly Sensitized Crossmatch-Positive Cadaveric Kidney Allograft Recipients , 2005, Transplantation.

[4]  P. Nickerson,et al.  National Conference to Assess Antibody‐Mediated Rejection in Solid Organ Transplantation , 2004, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[5]  E. Justrabo,et al.  Detection of donor-specific anti-HLA antibodies with flow cytometry in eluates and sera from renal transplant recipients with chronic allograft nephropathy1 , 2003, Transplantation.

[6]  Susan Martin,et al.  The detection and definition of IgM alloantibodies in the presence of IgM autoantibodies using flowPRA beads. , 2003, Human immunology.

[7]  M. Fishbein,et al.  Antibody‐Mediated Rejection Criteria – an Addition to the Banff ′97 Classification of Renal Allograft Rejection , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[8]  J. Bariéty,et al.  Desensitization and Subsequent Kidney Transplantation of Patients Using Intravenous Immunoglobulins (IVIg) , 2002, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[9]  R. Colvin,et al.  Acute humoral rejection in kidney transplantation: II. Morphology, immunopathology, and pathologic classification. , 2002, Journal of the American Society of Nephrology : JASN.

[10]  F. Gudat,et al.  Detection of the complement degradation product C4d in renal allografts: diagnostic and therapeutic implications. , 2002, Journal of the American Society of Nephrology : JASN.

[11]  W. Hörl,et al.  C4d-positive acute humoral renal allograft rejection: effective treatment by immunoadsorption. , 2001, Journal of the American Society of Nephrology : JASN.

[12]  R. Montgomery,et al.  PLASMAPHERESIS AND INTRAVENOUS IMMUNE GLOBULIN PROVIDES EFFECTIVE RESCUE THERAPY FOR REFRACTORY HUMORAL REJECTION AND ALLOWS KIDNEYS TO BE SUCCESSFULLY TRANSPLANTED INTO CROSS-MATCH-POSITIVE RECIPIENTS , 2000, Transplantation.

[13]  H. E. Hansen,et al.  The Banff 97 working classification of renal allograft pathology. , 1999, Kidney international.

[14]  R. Colvin,et al.  Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation. , 1998, Transplantation.

[15]  P. Berloco,et al.  Immunoadsorption with protein A in humoral rejection of kidney transplants. , 1996, ASAIO journal.

[16]  G. Riethmüller,et al.  Capillary deposition of C4d complement fragment and early renal graft loss. , 1993, Kidney international.

[17]  P. Halloran,et al.  THE SIGNIFICANCE OF THE ANTI–CLASS I RESPONSE , 1992, Transplantation.

[18]  G. Frascà,et al.  Effects of plasmapheresis in renal transplant rejection. A controlled study. , 1985, Transactions - American Society for Artificial Internal Organs.

[19]  P. Dyer,et al.  Plasma exchange in acute renal allograft rejection. A controlled trial. , 1983, Transplantation.

[20]  P. Dyer,et al.  PLASMA EXCHANGE IN ACUTE RENAL ALLOGRAFT REJECTION , 1983 .

[21]  A. Ythier,et al.  Plasma exchange in early kidney graft rejection associated with anti-donor antibodies. , 1983, Nephron.

[22]  A. Disney,et al.  A controlled trial of plasmapheresis in the treatment of renal allograft rejection. , 1981, Transplantation.

[23]  C. Cardella,et al.  Effect of intensive plasma exchange on renal transplant rejection and serum cytotoxic antibody. , 1978, Transplantation proceedings.