Immunoadsorption in Severe C4d-Positive Acute Kidney Allograft Rejection: A Randomized Controlled Trial

Böhmig, Georg A.; Wahrmann, Markus; Regele, Heinz; Exner, Markus; Robl, Bernhard; Derfler, Kurt; Soliman, Thomas; Bauer, Peter; Müllner, Marcus; Druml, Wilfred

doi:10.1111/j.1600-6143.2006.01613.x

Cited by 127 publications

(92 citation statements)

References 23 publications

(30 reference statements)

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“…If IVIGs are not effective, plasmapheresis or immunoadsorption are used to remove antibodies directly. Immunoadsorption alone has proven to be a very efficacious method [11] that is most often carried out six times every second day. Before this technique is performed, a Shaldon catheter must be placed.…”

Section: Histopathological Diagnosis Of Acute Antibody-mediated Rejecmentioning

confidence: 99%

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

et al. 2014

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Acute antibody-mediated rejection is a diagnostic challenge in renal transplantation medicine. However, it is an important diagnosis to make, since chronic antibody-mediated rejection (CAMR) is the main cause of long-term graft loss. Antibody-mediated rejection is diagnosed by detecting donorspecific antibodies (DSAs) in the blood in combination with observing typical histomorphological signs in kidney biopsy, as described in the Banff classification. Therapy is based on the removal of DSAs by administering intravenous immunoglobulins (IVIGs), plasmapheresis, or immunoadsorption. Reoccurrence of antibodies is diminished by the use of rituximab, increased immunosuppression, and in some cases additional experimental substances. A combination of these techniques has been shown to be successful in the majority of cases of acute and chronic antibody-mediated rejection. Routine DSA monitoring is warranted for early detection of antibody-mediated rejection.

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Section: Histopathological Diagnosis Of Acute Antibody-mediated Rejecmentioning

confidence: 99%

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

et al. 2014

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“…Following our local standard at that time, such treatment included tacrolimus rescue therapy or high-dose steroids (n=25) (18), a depleting antilymphocyte antibody (n=33), or immunoadsorption with or without a depleting antilymphocyte antibody (n=56), applied as a desensitization strategy in patients with broad panel reactivity (19) or as a treatment of established C4d+ rejection (20).…”

Section: Patients and Immunosuppressionmentioning

confidence: 99%

Capillary C4d and Kidney Allograft Outcome in Relation to Morphologic Lesions Suggestive of Antibody-Mediated Rejection

Kikić

Kainz

Kozakowski

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Recent studies highlighting a role of C4d2 antibody-mediated rejection (ABMR) have debated whether C4d staining has independent value as a rejection marker. Considering the presumed role of complement as an important effector of graft injury, this study hypothesized that capillary C4d, a footprint of antibody-triggered complement activation, indicates a particularly severe manifestation of ABMR.Design, setting, participants, & measurements This large retrospective clinicopathologic study sought to assess the clinical predictive value of C4d staining in relation to ABMR morphology. Overall, 885 renal allograft recipients who underwent transplantation between 1999 and 2006 (median duration of follow-up, 63.3 [interquartile range, 40.6-93.5] months; 206 graft losses) were included if they had had one or more indication biopsies. A total of 1976 biopsy specimens were reevaluated for capillary C4d staining (C4d data were available for 825 patients) and distinct morphologic lesions suggestive of ABMR, including glomerulitis, peritubular capillaritis, capillary microthrombi, transplant glomerulopathy, and severe intimal arteritis.Results C4d+ patients, with or without ABMR features, had worse death-censored 8-year graft survival (53% or 67%) than C4d2 patients (66% or 81%; P,0.001). In Cox regression analysis, C4d was associated with a risk of graft loss independently of baseline confounders and ABMR morphology (hazard ratio, 1.85 [95% confidence interval, 1.34 to 2.57]; P,0.001). The risk was higher than that observed for C4d2 patients, a finding that reached statistical significance in patients showing fewer than two different ABMR lesions. Moreover, in a mixed model, C4d was independently associated with a steeper decline of eGFR (slope per year, 28.2363.97 ml/min per 1.73 m 2 ; P,0.001).Conclusions These results suggest that detection of intragraft complement activation has strong independent value as an additional indicator of ABMR associated with adverse kidney transplant outcomes.

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“…Treatment regimens of plasmapheresis 34 or immunoadsorption 35 followed by low-dose intravenous immunoglobulin (IVIg; 100 mg/kg) or high-dose IVIg (2 g/kg) with or without steroids have become the SOC based on a preponderance of supporting data rather than randomized controlled trials. 36,37 High-dose IVIg is often used in combination with anti-CD20…”

Section: Treatment Of Amrmentioning

confidence: 99%

“…A small but well-designed study by Böhmig et al using immunoadsorption vs conventional immunosuppression for severe C4d-positive AMR was terminated early due to the high rate of graft loss in the control arm. 35 Another early randomized controlled trial comparing plasmapheresis with standard immunosuppression for early "vascular rejection" (not biopsy-proven AMR)…”

Section: Treatment Of Amrmentioning

confidence: 99%

Antibody-mediated rejection: New approaches in prevention and management

Montgomery

Loupy

Segev

2018

American Journal of Transplantation

111

102

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Estimated Time to Complete this Activity: 1.25 hours OverviewThis article reviews the pathophysiology of antibody-mediated rejection (AMR) with emphasis on the role of complement in allograft injury. It reviews the required features for a definitive diagnosis of AMR according to the latest Banff criteria, which incorporate recent findings delineating the complex spectrum of AMR and the diverse phenotypes seen. Clinical data on current and investigational treatments are summarized, and strategies to improve outcomes are presented. Lastly, a discussion of relevant predictive and surrogate endpoints provides a framework for future studies. Target AudienceThis activity has been designed to meet the educational needs of physicians, surgeons, scientists, nurses, organ procurement personnel, and pharmacists who care for patients with AMR. Educational ObjectivesAfter participating in this educational initiative, the participant should be better able to:• Explain the significance of activation of the complement system in the development of AMR Statement of SupportThis activity is jointly provided by RMEI Medical Education, LLC and Postgraduate Institute for Medicine. This activity is supported by an independent medical educational grant from Shire. For questions, please contact PIM at www.pimed.com. Joint Accreditation StatementIn support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and RMEI Medical Education, LLC. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Physician Continuing Medical EducationThe Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s) TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Continuing Pharmacy EducationPostgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.Postgraduate Institute for Medicine designates this continuing education activity for 1.25 contact hour(s) (0.125 CEUs) of the Accreditation Council for Pharmacy Education.[Correction added on 22 March, 2018, after first online publication: The accreditation statement and CEUs were updated.] (Universal Activity Number -0809-9999-17-584-H01-P) Please note: If you participated in the activity with UAN 0809-9999-16-209-L01-P, you are not able to claim credit for this activity.For Pharmacists: Upon successfully completing the post-test with a score of 75% or better and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service. Activity Type: Application Method of Participation and Request for CreditThere are no fees for participating and receiving CME credit for this...

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Immunoadsorption in Severe C4d-Positive Acute Kidney Allograft Rejection: A Randomized Controlled Trial

Cited by 127 publications

References 23 publications

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

Capillary C4d and Kidney Allograft Outcome in Relation to Morphologic Lesions Suggestive of Antibody-Mediated Rejection

Antibody-mediated rejection: New approaches in prevention and management

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