= Accepten for NEXT issue = ANTIBODY-MEDIATED REJECTION AFTER KIDNEY TRANSPLANTATION: AN OVERVIEW OF CURRENT TREATMENT OPTIONS Varsha Jharap, Manah Ahmadi, Saskia van Diessen en Ajda Rowshani email: [email protected] Abstract: Acute antibody-mediated rejection (AMR) after kidney transplantation is an uncommon but serious event, usually leading to graft loss. The current treatment modalities combine plasmapheresis and intravenous immunoglobulin (IVIg). Based on the currently available literature, we compared in this study the efficacy of the reported drug regimens either to treat or to prevent AMR. A Pubmed search was performed using kidney transplantation, graft rejection, humoral rejection and antibody-mediated rejection as search terms. Fourteen studies were identified. The different treatment regimens applied agents designed to combat the antibody formation and/or immune modulation of the effects of the antibodies. Plasmapheresis alone, IVIg alone, and combined plasmapheresis and IVIg either alone or together with rituximab, rabbit antithymocyte globulin, bortezomib, or splenctomy have been used to treat AMR. Complement inhibitor eculizumab was used in one study to prevent AMR in immunologically high risk transplant candidates. Evidence based conclusions can not be drawn from these studies because of the lack of sufficient data, small numbers of included patients, and the extended co-medication used which makes it impossible to specifically point out the efficacy of a certain drug. Therefore, we suggest to perform a multi-centre RCT with a clear design comparing the current standard therapy consisting of plasmapheresis and IVIG with eculizumab in a large cohort of patients who develop AMR looking at the graft survival and function as primary endpoints. A longer follow-up period from 5 to 10 years is desirable.
Posted on: Mon, 17 Mar 2014 09:05:34 +0000
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