Treatment of chronic active antibody-mediated kidney transplant rejection with intravenous immunoglobulin
Nadzeya Rapetskaya1, Kirill Komissarov2, Aleh Kalachyk2.
1Transplant nephrology, State institution Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus; 2Nephrology, renal replacement trerapy and kidney transplantation, State institution Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
Background and Aims: Chronic active antibody-mediated rejection (cAAMR) is one of the main causes of late allograft failure after kidney transplantation. Data on the management of chronic active antibody-mediated rejection after kidney transplantation are limited. Intravenous immunoglobulin (IVIg) is one of the treatment options known to have powerful and multiple immunomodulatory effects. High-dose IVIg delivers a lasting immunomodulatory effect on T cells and especially B cells, resulting in changes in the induction of B cell apoptosis and downstream modulation of B cell signaling.
Methods: This was a single-center study of kidney transplant recipients (n=10) treated with high-dose intravenous immunoglobulin for biopsy-confirmed cAAMR. IVIg infusions (1 g/kg) were performed every 4 weeks for 6 months. All patients were followed for at least 12 months clinically and by laboratory tests for graft and patient outcomes.
Results: Mean age of recruited patients was 47.3 ±12.74 years. Most of them had first kidney transplant. Glomerulonephritis represented the most common cause of end-stage kidney disease. The time frame for cAAMR development was 32 [7;60] month. 2 patients died from coronavirus COVID-19 and 4 (40%) patients started dialysis during the follow-up period. 4 (40%) kidney transplant recipients with functioning grafts had no significant changes in serum creatinine, glomerular filtration rate and proteinuria after treatment.
Conclusion: Monotherapy with intravenous immunoglobulin seems not to be an effective treatment strategy for chronic active antibody-mediated rejection of kidney transplant. New therapeutic approaches are needed to improve the outcome of cAAMR.
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