Cargando…

Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient

BACKGROUND: Antibody mediated rejection (AMR) and thrombotic microangiopathy (TMA) after kidney transplantation are difficult to differentiate most of the times and both play important roles in kidney allograft loss. Common treatment strategies of these two conditions include plasmapheresis, intrave...

Descripción completa

Detalles Bibliográficos
Autores principales: Dashti-Khavidaki, Simin, Shojaie, Lida, Hosni, Amin, Khatami, Mohammad Reza, Jafari, Atefeh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kowsar 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450162/
https://www.ncbi.nlm.nih.gov/pubmed/26034746
http://dx.doi.org/10.5812/numonthly.7(3)2015.27073
_version_ 1782373967005220864
author Dashti-Khavidaki, Simin
Shojaie, Lida
Hosni, Amin
Khatami, Mohammad Reza
Jafari, Atefeh
author_facet Dashti-Khavidaki, Simin
Shojaie, Lida
Hosni, Amin
Khatami, Mohammad Reza
Jafari, Atefeh
author_sort Dashti-Khavidaki, Simin
collection PubMed
description BACKGROUND: Antibody mediated rejection (AMR) and thrombotic microangiopathy (TMA) after kidney transplantation are difficult to differentiate most of the times and both play important roles in kidney allograft loss. Common treatment strategies of these two conditions include plasmapheresis, intravenous immunoglobulin (IVIG) and rituximab. OBJECTIVES: This study was designed to assess the efficacy of routine treatment of AMR/TMA in Iranian kidney transplant recipients, which comprises of plasmapheresis and IVIG. PATIENTS AND METHODS: This one-year cross-sectional study was performed in the Kidney Transplantation Ward of Imam-Khomeini Hospital Complex, Tehran, Iran. All kidney transplant recipients who were administered plasmapheresis and IVIG to treat definite or suggested AMR or TMA were assessed clinically and also evaluated on laboratory data. RESULTS: During 2014, we encountered five patients with suspicious AMR or TMA at our kidney transplant center. Renal biopsy was performed for two of them, suggesting AMR for one patient and TMA for another patient. All patients were treated with plasmapheresis plus IVIG. In this center, as a routine practice, the cumulative dose of 2 g/kg of IVIG was divided to 300 - 400 mg/kg after each plasmapheresis. Only one out of the five patients showed response, albeit not completely. CONCLUSIONS: Due to daily plasmapheresis within the first several days after AMR or TMA, administering high amounts of the cumulative dose of IVIG after plasmapheresis may result in high amounts of IVIG withdrawal by plasmapheresis and response failure. Our suggestion is to reduce the IVIG dose after each plasmapheresis to 100 mg/kg (i.e. replacement dose) to reach a cumulative dose of 2 g/Kg. If plasmapheresis treatment is initiated sooner than the completion of the IVIG cumulative dose of 2 g/kg, the remaining dose can be administered during one injection.
format Online
Article
Text
id pubmed-4450162
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Kowsar
record_format MEDLINE/PubMed
spelling pubmed-44501622015-06-01 Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient Dashti-Khavidaki, Simin Shojaie, Lida Hosni, Amin Khatami, Mohammad Reza Jafari, Atefeh Nephrourol Mon Research Article BACKGROUND: Antibody mediated rejection (AMR) and thrombotic microangiopathy (TMA) after kidney transplantation are difficult to differentiate most of the times and both play important roles in kidney allograft loss. Common treatment strategies of these two conditions include plasmapheresis, intravenous immunoglobulin (IVIG) and rituximab. OBJECTIVES: This study was designed to assess the efficacy of routine treatment of AMR/TMA in Iranian kidney transplant recipients, which comprises of plasmapheresis and IVIG. PATIENTS AND METHODS: This one-year cross-sectional study was performed in the Kidney Transplantation Ward of Imam-Khomeini Hospital Complex, Tehran, Iran. All kidney transplant recipients who were administered plasmapheresis and IVIG to treat definite or suggested AMR or TMA were assessed clinically and also evaluated on laboratory data. RESULTS: During 2014, we encountered five patients with suspicious AMR or TMA at our kidney transplant center. Renal biopsy was performed for two of them, suggesting AMR for one patient and TMA for another patient. All patients were treated with plasmapheresis plus IVIG. In this center, as a routine practice, the cumulative dose of 2 g/kg of IVIG was divided to 300 - 400 mg/kg after each plasmapheresis. Only one out of the five patients showed response, albeit not completely. CONCLUSIONS: Due to daily plasmapheresis within the first several days after AMR or TMA, administering high amounts of the cumulative dose of IVIG after plasmapheresis may result in high amounts of IVIG withdrawal by plasmapheresis and response failure. Our suggestion is to reduce the IVIG dose after each plasmapheresis to 100 mg/kg (i.e. replacement dose) to reach a cumulative dose of 2 g/Kg. If plasmapheresis treatment is initiated sooner than the completion of the IVIG cumulative dose of 2 g/kg, the remaining dose can be administered during one injection. Kowsar 2015-05-23 /pmc/articles/PMC4450162/ /pubmed/26034746 http://dx.doi.org/10.5812/numonthly.7(3)2015.27073 Text en Copyright © 2015, Nephrology and Urology Research Center. http://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
spellingShingle Research Article
Dashti-Khavidaki, Simin
Shojaie, Lida
Hosni, Amin
Khatami, Mohammad Reza
Jafari, Atefeh
Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient
title Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient
title_full Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient
title_fullStr Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient
title_full_unstemmed Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient
title_short Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient
title_sort effectiveness of intravenous immunoglobulin plus plasmapheresis on antibody-mediated rejection or thrombotic microangiopathy in iranian kidney transplant recipient
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450162/
https://www.ncbi.nlm.nih.gov/pubmed/26034746
http://dx.doi.org/10.5812/numonthly.7(3)2015.27073
work_keys_str_mv AT dashtikhavidakisimin effectivenessofintravenousimmunoglobulinplusplasmapheresisonantibodymediatedrejectionorthromboticmicroangiopathyiniraniankidneytransplantrecipient
AT shojaielida effectivenessofintravenousimmunoglobulinplusplasmapheresisonantibodymediatedrejectionorthromboticmicroangiopathyiniraniankidneytransplantrecipient
AT hosniamin effectivenessofintravenousimmunoglobulinplusplasmapheresisonantibodymediatedrejectionorthromboticmicroangiopathyiniraniankidneytransplantrecipient
AT khatamimohammadreza effectivenessofintravenousimmunoglobulinplusplasmapheresisonantibodymediatedrejectionorthromboticmicroangiopathyiniraniankidneytransplantrecipient
AT jafariatefeh effectivenessofintravenousimmunoglobulinplusplasmapheresisonantibodymediatedrejectionorthromboticmicroangiopathyiniraniankidneytransplantrecipient