Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation

Manuel Pascual, Susan Saidman, Nina Tolkoff-Rubin, Winfred W. Williams, Shamila Mauiyyedi, Ji Ming Duan, Mary Lin Farrell, Robert B. Colvin, A. Benedict Cosimi, Francis L. Delmonico

Research output: Contribution to journalArticlepeer-review

185 Scopus citations

Abstract

Background. Acute renal allograft rejection associated with the development of donor-specific alloantibody (acute humoral rejection, AHR) typically carries a poor prognosis. The best treatment of this condition remains undefined. tk;2Methods. During a 14-month period, 73 renal transplants were performed. During the first postoperative month, five recipients (6.8%) with AHR were identified. The diagnosis was based on: (1) evidence of severe rejection, resistant to steroid and antilymphocyte therapy; (2) typical pathologic features; and (3) demonstration of donor- specific alloantibody (DSA) in recipient's serum at the time of rejection. Pretransplant donor-specific T- and B-cell cross-matches were negative. Results. Plasma exchange (PE, four to seven treatments per patient) significantly decreased circulating DSA to almost pretransplant levels in four of five patients, and improvement in renal function occurred in all patients. one patient had recurrent renal dysfunction in the setting of an increase in circulating DSA. A second series of five PE treatments decreased DSA and reversed the rejection episode. Rescue therapy with tacrolimus (initial mean dose: 0.14±0.32 mg/kg/day) and mycophenolate mofetil (2 g/day) was used in five of five and four of five patients, respectively. With a mean follow-up of 19.6±5.6 months, patient and allograft survival are 100%. Renal function remains excellent with a mean current serum creatinine of 1.2±0.3 mg/dl. (range: 0.9-1.8 mg/dl). Conclusions. Our findings suggest that a therapeutic approach combining PE and tacrolimus-mycophenolate mofetil rescue has the potential to improve the outcome of AHR.

Original languageEnglish (US)
Pages (from-to)1460-1464
Number of pages5
JournalTransplantation
Volume66
Issue number11
DOIs
StatePublished - Dec 15 1998
Externally publishedYes

ASJC Scopus subject areas

  • Transplantation

Fingerprint

Dive into the research topics of 'Plasma exchange and tacrolimus-mycophenolate rescue for acute humoral rejection in kidney transplantation'. Together they form a unique fingerprint.

Cite this