Application of plasmapheresis in treating the antibody-mediated acute rejection after kidney transplantation

Abstract

Objective To investigate the efficacy of plasmapheresis therapy for treating the antibody-mediated acute rejection (AMR) after kidney transplantation. Methods The study group consists of 2 male patients and 3 female patients, who suffered with AMR after receiving first-time allograft renal transplantation from January 2011 to September 2013 in our hospital. The age ranged from 41 to 52 years old, average 46 years old. The preoperative diagnosis in all patients was chronic renal insufficiency (uremia stage) and the regular hemodialysis was given to them. The 5 patients received basic immunosuppressive therapy, including cyclosporine A [5 mg/(kg·d)] or FK506 [0.1 mg/(kg·d)], mycophenolate mofetil (MMF) (1.5 g/d) and steroids. All the antibody-mediated acute rejections were diagnosed by renal allograft biopsy and serum DSA determination within 2 weeks after transplantation. Seven cycles of plasmapheresis rescue therapy were given to those patients respectively after the failure therapy of high dose of corticosteroids (1 000 mg/d) and ALG (250 mg/d). 4 cases with primary glomerulonephritis, whose preoperative serum creatinine level was (784±154) μmol/L, were given plasmapheresis therapy within 2 weeks after transplantation. One case with primary anti-glomerular basement membrane disease, whose preoperative serum creatinine level was 935 μmol/L, received plasmapheresis 35 d after transplantation. The serum DSA in all patients was positive before plasmapheresis. Results After 7 cycles of plasmapheresis rescue therapy, the AMR was reversed in four 4 cases, whose plasmapheresis was given within 2 weeks after transplantation. Within three months follow-up, their renal function recovered well, which the mean serum creatinine level was (113±12) μmol/L. In the case, whose plasmapheresis was given 35 days after transplantation, rejection was not reversed. His serum creatinine was 524 μmol/L and the intermittent hemodialysis was given, subsequently. With a follow-up of 12 months, the ultrasound examination showed that the atrophy of transplanted kidney and a high level of serum creatinine (758 μmol/L). Low dose of FK506 (0.5 mg/d) was given based on those results. Conclusions Active application of plasmapheresis can effectively reverse antibody-mediated acute rejection within two weeks after transplantation. Key words: Kidney transplantation; Antibody-mediated acute rejection; Plasmapheresis