Rabbit anti-human thymocyte immunoglobulin for the rescue treatment of chronic antibody-mediated rejection after pediatric kidney transplantation

Cihan, Yasemen; Kanzelmeyer, Nele; Drube, Jens; Kreuzer, Martin; Lerch, Christian; Hennies, Imke; Froede, Kerstin; Verboom, Murielle; Ahlenstiel-Grunow, Thurid; Pape, Lars

doi:10.1007/s00467-017-3725-1

Cited by 6 publications

(2 citation statements)

References 54 publications

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“…We saw that adjunctive therapy with thymoglobulin failed to achieve a significant improvement in allograft survival rates among some recipients with ABMR. Cihan et al found a significant amelioration of allograft function in 4 of 9 pediatric kidney transplant recipients with chronic ABMR, but larger studies are lacking ( 48 ).…”

Section: Discussionmentioning

confidence: 99%

Differential Treatment Effects for Renal Transplant Recipients With DSA-Positive or DSA-Negative Antibody-Mediated Rejection

et al. 2022

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BackgroundAntibody-mediated rejection (ABMR) is the main cause of renal allograft loss. The most common treatment strategy is based on plasmapheresis plus the subsequent administration of intravenous immunoglobulin (IVIG). Unfortunately, no approved long-term therapy is available for ABMR. The current study was designed to analyze the effect of various ABMR treatment approaches on allograft survival and to compare treatment effects in the presence or absence of donor-specific antibodies (DSAs).MethodsThis single-center study retrospectively analyzed 102 renal allograft recipients who had biopsy-proven ABMR after transplant. DSA was detectable in 61 of the 102 patients. Initial standard treatment of ABMR consisted of plasmapheresis (PS) or immunoadsorption (IA), followed by a single course of IVIG. In case of nonresponse or recurrence, additional immunosuppressive medications, such as rituximab, bortezomib, thymoglobulin, or eculizumab, were administered. In a second step, persistent ABMR was treated with increased maintenance immunosuppression, long-term therapy with IVIG (more than 1 year), or both.ResultsOverall graft survival among transplant patients with ABMR was <50% after 3 years of follow-up. Compared to the use of PS/IA and IVIG alone, the use of additional immunosuppressive medications had no beneficial effect on allograft survival (p = 0.83). Remarkably, allografts survival rates were comparable between patients treated with the combination of PS/IA and IVIG and those treated with a single administration of IVIG (p = 0.18). Renal transplant patients with ABMR but without DSAs benefited more from increased maintenance immunosuppression than did DSA-positive patients with ABMR (p = 0.01). Recipients with DSA-positive ABMR exhibited significantly better allograft survival after long-term application of IVIG for more than 1 year than did recipients with DSA-negative ABMR (p = 0.02).ConclusionsThe results of our single-center cohort study involving kidney transplant recipients with ABMR suggest that long-term application of IVIG is more favorable for DSA-positive recipients, whereas intensification of maintenance immunosuppression is more effective for recipients with DSA-negative ABMR.

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Section: Discussionmentioning

confidence: 99%

Differential Treatment Effects for Renal Transplant Recipients With DSA-Positive or DSA-Negative Antibody-Mediated Rejection

et al. 2022

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“…These results are plausibly influenced by the absence of PLEX in the first two groups but may suggest noninferiority of ATG to IVIG in vascular rejection. Cihan et al 33 . published a descriptive non‐controlled study with the use of ATG as a rescue treatment in nine chronic AMR in children resistant Steroids/IVIG/Rituximab ± Bortezomib, showing a reversal of graft function degradation in six of the nine cases, with a clear improvement of the graft function in four of them at 9 months after ATG administration.…”

Section: Adjuvant Therapiesmentioning

confidence: 99%

Antibody‐mediated rejection after kidney transplantation in children; therapy challenges and future potential treatments

Bertacchi

Parvex

Villard

2022

Clinical Transplantation

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Antibody-mediated rejection (AMR) remains one of the most critical problems in renal transplantation, with a significant impact on patient and graft survival. In the United States, no treatment has received FDA approval jet. Studies about treatments of AMR remain controversial, limited by the absence of a gold standard and the difficulty in creating large, multi-center studies. These limitations emerge even more in pediatric transplantation because of the limited number of pediatric studies and the occasional use of some therapies with unknown and poorly documented side effects. The lack of recommendations and the unsharp definition of different forms of AMR contribute to the challenging management of the therapy by pediatric nephrologists. In an attempt to help clinicians involved in the care of renal transplanted children affected by an AMR, we rely on the latest recommendations of the Transplantation Society (TTS) for the classification and treatment of AMR to describe treatments available today and potential new treatments with a particular focus on the pediatric population.

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Characterizing the frequency of modifiable histological changes observed on surveillance biopsies in pediatric kidney allograft recipients

et al. 2020

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Rabbit anti-human thymocyte immunoglobulin for the rescue treatment of chronic antibody-mediated rejection after pediatric kidney transplantation

Abstract: In this small series of patients, rATG appears a promising treatment for unresponsive cAMR. Further evaluation, including earlier introduction of rATG, is warranted.

Cited by 6 publications

References 54 publications

Differential Treatment Effects for Renal Transplant Recipients With DSA-Positive or DSA-Negative Antibody-Mediated Rejection

Differential Treatment Effects for Renal Transplant Recipients With DSA-Positive or DSA-Negative Antibody-Mediated Rejection

Antibody‐mediated rejection after kidney transplantation in children; therapy challenges and future potential treatments

Characterizing the frequency of modifiable histological changes observed on surveillance biopsies in pediatric kidney allograft recipients

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