Konstantin Doberer1, Gregor Bond2, Johannes Kläger3, Heinz Regele3, Robert Strassl4, Roman Reindl-Schwaighofer1, Georg Scheriau5, Markus Wahrmann1, Željko Kikić1, Ingrid Faé6, Gottfried Fischer6, Georg A Böhmig1, Farsad Eskandary1. 1. Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria. 2. Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria, gregor.bond@meduniwien.ac.at. 3. Department of Pathology, Medical University Vienna, Vienna, Austria. 4. Department of Clinical Virology, Medical University Vienna, Vienna, Austria. 5. Department of Anaesthesia, Intensive Care and Pain Medicine, Medical University Vienna, Vienna, Austria. 6. Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria.
Abstract
INTRODUCTION: Immunoadsorption (IA) represents a therapeutic option for acute antibody-mediated rejection (ABMR) after kidney transplantation. The addition of membrane filtration (MF) to enhance elimination of macromolecular components that potentially contribute to rejection, such as key complement component C1q and alloreactive IgM, may be an effective strategy to further improve its therapeutic efficiency. RESULTS: Here we present 4 consecutive patients with episodes of HLA donor-specific antibody-positive ABMR nonresponsive to cycles of 6-16 sessions of IA treatment. Rejection episodes were characterized by severe microvascular injury (high-grade microcirculation inflammation and/or signs of thrombotic microangiopathy) and evidence of intense complement activation in peritubular capillaries (diffuse C4d-positivity). IA combined with MF led to substantial morphologic improvement (follow-up biopsies: g + ptc and C4d scores ≤1) and stabilization of allograft function. CONCLUSIONS: Our findings provide evidence for an effect of combination of IA + MF in refractory early acute/active ABMR in kidney transplant recipients.
INTRODUCTION: Immunoadsorption (IA) represents a therapeutic option for acute antibody-mediated rejection (ABMR) after kidney transplantation. The addition of membrane filtration (MF) to enhance elimination of macromolecular components that potentially contribute to rejection, such as key complement component C1q and alloreactive IgM, may be an effective strategy to further improve its therapeutic efficiency. RESULTS: Here we present 4 consecutive patients with episodes of HLA donor-specific antibody-positive ABMR nonresponsive to cycles of 6-16 sessions of IA treatment. Rejection episodes were characterized by severe microvascular injury (high-grade microcirculation inflammation and/or signs of thrombotic microangiopathy) and evidence of intense complement activation in peritubular capillaries (diffuse C4d-positivity). IA combined with MF led to substantial morphologic improvement (follow-up biopsies: g + ptc and C4d scores ≤1) and stabilization of allograft function. CONCLUSIONS: Our findings provide evidence for an effect of combination of IA + MF in refractory early acute/active ABMR in kidney transplant recipients.
Authors: Konstantin Doberer; Martin Schiemann; Robert Strassl; Frederik Haupenthal; Florentina Dermuth; Irene Görzer; Farsad Eskandary; Roman Reindl-Schwaighofer; Željko Kikić; Elisabeth Puchhammer-Stöckl; Georg A Böhmig; Gregor Bond Journal: Am J Transplant Date: 2020-03-08 Impact factor: 8.086