Clinicopathological Analysis of 15-Deoxyspergualin Rescue Therapy for Chronically Damaged Kidney Allograft Function: Japan Multicenter Cooperative Study.

Abstract

INTRODUCTION: Chronically allograft damage of kidney graft is rebellious situation, however; it should be overcome to obtain longer lasting allograft survival. We conducted the multicenter cooperative study using 15-deoxyspergualin (DSG) for chronically damaged kidney grafts and reported (ATC 2012). We herein report the result of expanded cases and investigated mechanistic background. METHODS: Thirty-five kidney transplant recipients whose graft was chronically damaged (22 chronic antibody mediated rejection, 1 chronic T-cell mediated rejection, 10 interstitial fibrosis and tubular atrophy, and 2 unknown cause) with creeping creatinine and urine protein secretion were enrolled and treated with multi-sessions of DSG with written permission. DSG (3-5 mg/kg, each) were administrated intravenously for 5 consecutive days and repeated every month for 6 months. We evaluated the safety of this treatment and the efficacy according to the monthly examinations. Their pathological diagnosis according Banff ‘07 score were evaluated. Moreover, pathological change in acute change judged by g or ptc score and that in chronic change by cg or ptcbm between pre- and post-DSG inoculation. RESULTS: As shown in previous ATC meeting, DSG improved sCr (1.9 to 1.6 mg/dl) and urine decreased albumin excretion (424.9 to 219.4 mg/dl) after the termination of DSG treatment with minimum anemia progression. Their each pathological parameter (t, i, v, ah, ptc, g, ct, ci, ptcbm, cg, ti) were not significantly differed from pre- and post-DSG except for cv. Interestingly the improvement of acute change (g/ptc) were seen in 57%, but only 36% of chronic change (cg/ptcbm) exhibited improvement.Figure: No Caption available.CONCLUSION: Long-term DSG treatment can recover chronically damaged graft function without any life-threatening adverse event. It would be brought more likely by the improvement of acute change than by that of chronic change.