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Treatment for early-onset antibody-mediated rejection after kidney transplantation / 中华器官移植杂志
Article in Chinese | WPRIM | ID: wpr-610588
Responsible library: WPRO
ABSTRACT
Objective To describe the experiences when different methods were used to treat early-onset antibody-mediated rejection (AMR) after kidney transplantation.Methods The clinical data of 42 recipients who experienced early-onset acute AMR after kidney transplantation in our department from Jan.2010 to Apr.2016 were retrospectively analyzed.The recipients were divided into 3 groups based on different strategies against AMRgroup A (plasma exchange with intravenous immunoglobin);group B (bortezomib solo),and group C (combination of bortezomib and sirolimus).Results All the AMR episodes were diagnosed by kidney biopsy 9-27 days after transplantation.The AMR reversal rate in groups B and C was significantly higher than that in group A (100% versus 60.00%,P=0.034;100% versus 60.00%,P=0.007).The AMR recurrence rate in groups B and C was significantly lower than that in group A (0 versus 41.67%,P =0.035;0 versus 41.67%,P =0.007).The recipient survival rate was 100% in all the three groups.There were 11 graft losses in group A,and none in group B or C.The graft survival rate in group B at 6 months,1 year and 3 years was significantly higher than in group A (100% versus 60.00%,P =0.034;100% versus 55.00%,P =0.021;100% versus 50.00%,P =0.013).The graft survival rate in group C at 6 months and 1 year was significantly higher than in group A (100% versus 60.00%,P =0.007;100% versus 55.00%,P =0.003).There was no significant difference in AMR reversal rate,AMR recurrence rate and graft survival rate between groups B and C.There was no significant difference in incidences of infection,hyperlipidemia and bone marrow suppression among the three groups.The incidence of diarrhea in groups B and C was significantly higher than in group A (50.00% versus 0,P =0.001;42.86% versus 0,P =0.001).The incidence of peripheral neuritis in group B was significantly higher than in group A (25.00% versus 0,P =0.02),but similar to group C.There was no significant difference in average serum creatinine level among three groups within 1 year after treatment (P> 0.05).Antibodies against human leukocyte antigen (HLA) and donor specific antibodies were detected in all the 42 recipients before treatment.The negative conversion ratio of panel reactive antibody (PRA) in group A was significantly lower than in groups B and C (10.00% versus 87.50%,P< 0.001;10.00% versus 92.86%,P < 0.001).The PRA recurrence rate in group A was significantly higher than in groups B and C (85.00% versus 37.50%,P<0.001;85.00% versus 0,P<0.001),while that in group B was significantly higher than in group C (37.50% versus 0,P =0.014).The ratio of Treg in peripheral blood at 3-12 month after treatment in group C was significantly higher than in groups A and B (P<0.05).Conclusion Treatment for early-onset AMR after kidney transplantation based on bortezomib might be an effective and safe strategy.Graft longterm survival might benefit from the combination of bortezomib and sirolimus.

Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of Organ Transplantation Year: 2017 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of Organ Transplantation Year: 2017 Type: Article