Plasmapheresis and cyclophosphamide in the treatment of humoral rejection after heart transplantation

Grauhan, O.; Knosalla, Christoph; Ewert, Ralf; Hummel, Manfred; Loebe, Matthias; Weng, Y.; Hetzer, Roland

doi:10.1016/s1053-2498(00)00211-4

Cited by 79 publications

(45 citation statements)

References 12 publications

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“…In other published plasmapheresis series (8,18), the number of sessions has varied from 3 to 19; our patients underwent a minimum of 7 daily sessions, and if the rejection episode had not resolved by then, daily sessions were continued until it did resolve. The maximum number of sessions applied was 19.…”

Section: Discussionmentioning

confidence: 99%

Humoral Heart Rejection (Severe Allograft Dysfunction with no Signs of Cellular Rejection or Ischemia): Incidence, Management, and the Value of C4d for Diagnosis

Crespo‐Leiro¹,

Veiga‐Barreiro²,

Doménech

et al. 2005

American Journal of Transplantation

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Severe allograft dysfunction after heart transplant (HT), without ischemia or evidence of cellular rejection upon endomyocardial biopsy (EMB), is a rare but potentially fatal condition that suggests humoral rejection (HR). Its incidence, and the methods of choice for its diagnosis and management, remain uncertain. We retrospectively studied 445 HT patients (April 1991-December 2003) to determine incidence of HR diagnosed by clinical and conventional histopathological criteria. We used immunofluorescence (IF) techniques to test archived frozen EMB issue for IgM, IgG, C1q, C3, fibrin and C4d. Twelve patients (2.7%) fulfilled the criteria for HR after a mean time post-HT of 21.3 ± 24.7 months (range: 2-72 months). Patients were treated with high doses of steroids and plasmapheresis, with successful recovery in 11 cases. IF studies using classical markers were mainly negative for the six patients with enough EMB tissue for testing. All six patients showed positivity for C4d during the HR episode but not before or after. Humoral rejection was observed in less than 3% of HT patients. Plasmapheresis treatment was highly effective. Classical IF tests were not useful for diagnosis, but C4d appears to be useful both for confirmation of diagnosis and for monitoring response to treatment.

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Section: Discussionmentioning

confidence: 99%

Humoral Heart Rejection (Severe Allograft Dysfunction with no Signs of Cellular Rejection or Ischemia): Incidence, Management, and the Value of C4d for Diagnosis

Crespo‐Leiro¹,

Veiga‐Barreiro²,

Doménech

et al. 2005

American Journal of Transplantation

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“…This concept is supported by tissue expression of regulators of complement activation concomitant with C4d deposition. 84 In other asymptomatic recipients, it is unclear whether complement deposition reflects accommodation or subclinical AMR. Patients with subclinical AMR are not generally treated, because more data regarding the significance of a positive biopsy in the absence of symptoms are needed.…”

Section: Subclinical Amrmentioning

confidence: 99%

“…123 A number of small case series have reported on its use for the treatment of de novo and refractory AMR in cardiac transplantation. 11,84,125 Additionally, there are several case reports describing the use of plasma exchange for decreasing alloantibody levels in highly sensitized patients awaiting heart transplantation. 126,127 Plasma exchange has also been reported to facilitate transplantation across a positive crossmatch by decreasing the likelihood of subsequent allograft rejection.…”

Section: Intravenous Gamma Globulinmentioning

confidence: 99%

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Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Colvin¹,

Cook²,

Chang³

et al. 2015

Circulation

274

251

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“…Corticosteroids or antilymphocyte antibodies are not sufficiently effective; it is necessary to eliminate the antibodies present in blood and prevent their further formation (10). The available elimination methods are plasmapheresis and immunoadsorption (11,12), both of which were successfully used in our patients. The elimination is usually completed by administration of intravenous immunoglobulin, which inhibits residual antibodies.…”

Section: Original Articlementioning

confidence: 99%

Experience with cellular and antibody mediated rejection after heart transplantation

Málek¹,

GazdicÂ²,

Hegarová³

et al. 2015

Curr Res Cardiol

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ObjECTIvEs: To evaluate celluar and antibody mediated rejection in a group of patients after heart transplantation (HTX), performed in the authors' institution during a six-year period. METHOd: A retrospective analysis of patients surviving ≥12 months after HTX was performed. Rejection was evaluated from the samples obtained during endomyocardial biopsy, and graft function was assessed using echocardiography. The duration of follow-up ranged from 12 to 72 months. REsulTs:In the 196 patients evaluated, 65 treated episodes of cellular rejection were recorded in 50 patients, with significant reduction on tacrolimus prophylaxis. Antibody mediated rejection occured in 5.6% of patients, and was complicated by graft dysfunction in 64%. COnClusIOn: Contemporary immunosuppressive prophylaxis decreases the frequency of cellular rejection, allowing modification of endomyocardial biopsy schedule. Antibody mediated rejection is a relatively rare but clinically important complication after HTX, and necessitates combined agressive therapy.

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Plasmapheresis and cyclophosphamide in the treatment of humoral rejection after heart transplantation

Cited by 79 publications

References 12 publications

Humoral Heart Rejection (Severe Allograft Dysfunction with no Signs of Cellular Rejection or Ischemia): Incidence, Management, and the Value of C4d for Diagnosis

Humoral Heart Rejection (Severe Allograft Dysfunction with no Signs of Cellular Rejection or Ischemia): Incidence, Management, and the Value of C4d for Diagnosis

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Experience with cellular and antibody mediated rejection after heart transplantation

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