Plasmapheresis and intravenous immunoglobulin in early antibody-mediated rejection of the renal allograft: a single-center experience.

Antibody-mediated rejection (AMR) is a rare complication which often results in the loss of the kidney graft. The objective of this retrospective single center study was to evaluate two different approaches to AMR. We retrospectively evaluated data files from 936 patients who had undergone renal transplantation in 2002-2006. In 2002-2003, patients with AMR were treated with five plasmapheresis sessions (PP group, N = 13), and in 2004-2006 they received five plasmapheresis session along with intravenous immunoglobulin 0.5 g/kg (PP+IVIg group, N = 11). Twelve months of follow-up data was analyzed. First year graft survival was significantly higher in the PP+IVIg group than in the PP group (90.9% vs. 46.2%; P = 0.044); similarly, patient survival was higher in the PP+IVIg group (100% vs. 76.9%; P = 0.056). The incidence of infectious complications was similar in both groups. In re-biopsies, patients in the PP group often suffered from cellular rejection. The deposition of C4d complement was similar in re-biopsies in both groups. In this large single center study we proved the superiority of plasmapheresis with intravenous immunoglobulin administration in the treatment of early AMR of renal allografts.