Renal Transplantation in the ANCA-Associated Vasculitides

Geetha, Duvuru; Seo, Philip

doi:10.1111/j.1600-6143.2007.01988.x

Cited by 34 publications

(10 citation statements)

References 47 publications

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“…Kidney ANCA‐associated vasculitis generally responds well to high‐dose prednisolone and cyclophosphamide (231–233). Other treatment modalities that have been tried include MMF, plasmapheresis with or without intravenous immunoglobulin and rituximab (234–240).…”

Section: Rationalementioning

confidence: 99%

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,163

294

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Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2009.02834.x S2 American Journal of Transplantation 2009; 9 (Suppl 3): S2-S2Since the first successful kidney transplantation in 1954 It is our hope that this document will serve several useful purposes. Our primary goal is to improve patient care. We hope to accomplish this in the short term by helping clinicians know and better understand the evidence (or lack of evidence) that determines current practice. By making this guideline broadly applicable, our purpose is to also encourage and enable the establishment and development of transplant programs worldwide. Finally, by providing comprehensive evidence-based recommendations, this guideline will also help define areas where evidence is lacking and research is needed. Helping to define a research agenda is an often neglected, but very important function of clinical practice guideline development.We used the GRADE system to rate the strength of evidence and the strength of recommendations. In all, there were only 4 (2%) recommendations in this guideline for which the overall quality of evidence was graded 'A,' whereas 27 (13.6%) were graded 'B,' 77 (38.9%) were graded 'C,' and 90 (45.5%) ' and 148 (74.7%) graded '2.' There were 3 (1.5%) recommendations graded '1A,' 16 (8.1%) were '1B,' 18 (9.1%) were '1C, ' and 13 (6.6%) were '1D.' There was 1 (0.5%) graded '2A,' 11 (5.6%) were '2B,' 59 (29.8%) were '2C, ' and 77 (38.9%) BackgroundExcept perhaps for transplantation between identical twins, all kidney transplant recipients (KTRs) need immunosuppressive medications to prevent rejection. Induction therapy is treatment with a biologic agent, either a lymphocyte-depleting agent or an interleukin 2 receptor antagonist (IL2-RA), begun before, at the time of, or immediately after transplantation. The purpose of induction therapy is to deplete or modulate T-cell responses at the time of antigen presentation. Induction therapy is intended to improve the efficacy of immunosuppression by reducing acute rejection, or by allowing a reduction of other components of the regimen, such as calcineurin inhibitors (CNIs) or corticosteroids. Available lymphocytedepleting agents include antithymocyte globulin (ATG), antilymphocyte globulin (ALG) and monomurab-CD3. Basiliximab and daclizumab, the two IL2-RAs that are currently available in many parts of the world, bind the CD25 antigen (interleukin-2 [IL2] receptor a-chain) at the surface of activated T-lymphocytes and thereby competitively inhibit IL2-mediated lymphocyte activation, a crucial phase in cellular immune response of allograft rejection. Rationale• There is high-quality evidence that the benefits of IL2-RA vs. no IL2-RA (or placebo) outweigh harm in a broad range of KTRs with variable immunological risk and concomitant immunosuppressive medication regimens.• There is moderate-quality evidence that a lymphocytedepleting agent vs. no lymphocyte-depleting a...

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Section: Rationalementioning

confidence: 99%

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,163

294

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“…We have described a cohort of patients with WG and MPA who have had excellent graft survival rate and a lower rate of vasculitis relapse than reported in other series 2,9,14 . It is tempting to speculate that a mycophenolate mofetil/tacrolimus-based regimen may be more effective than other immunosuppressive regimens for patients with AAV who undergo kidney transplant.…”

Section: Discussionmentioning

confidence: 71%

Renal Transplant in Wegener’s Granulomatosis Compared to Microscopic Polyangiitis

Geetha

Haas

Kraus³

et al. 2010

J Rheumatol

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“…In patients with the recurrent disease, re-introduction of cyclophosphamide has been the main therapeutic strategy [15]. Plasma exchange and rituximab were also used in some cases [16,17], especially with pulmonary involvement and high ANCA titers.…”

Section: Discussionmentioning

confidence: 99%

De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

et al. 2014

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A 61-year-old woman was admitted to our hospital because of an unexpected rise in serum creatinine (sCr) level with proteinuria and microhematuria. She had undergone living-donor kidney transplantation 31 years before for end-stage renal disease caused by chronic glomerulonephritis (GN). On admission, her sCr was 1.27 mg/ dL which was increased from 0.6 mg/dL, urinary protein/ creatinine ratio was 1.39 g/gCr, and urinary red blood cell count was more than 100 per high power field. The allograft biopsy revealed crescentic glomerulonephritis with moderate to severe tubulointerstitial inflammation. Immunofluorescence staining yielded only a minimal staining for immunoglobulin A, and negative C4d in peritubular capillary. Since increased myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titer of 45.5 U/mL was detected, we made the diagnosis of post-transplant MPO-ANCA-associated GN. She was treated with three doses of bolus methylprednisolone (500 mg) followed by oral prednisolone therapy. Her sCr was stable at 1.20 mg/ dL thereafter. ANCA-associated GN should be considered in older kidney transplant patients with new-onset urinary abnormalities because typical systemic symptoms and vasculitis in other organs might be masked by maintenance immunosuppression.

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Renal Transplantation in the ANCA-Associated Vasculitides

Cited by 34 publications

References 47 publications

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Renal Transplant in Wegener’s Granulomatosis Compared to Microscopic Polyangiitis

De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

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