RESUMO
Antibody-mediated rejection (AMR) generally occurs in highly sensitized patients. A pilot study was performed on 7 consecutive patients with AMR to assess the efficacy of high-dose intravenous immunoglobulin (IVIG; 2 g/kg) + rituximab (RTX; 375 mg/m(2)) without plasmapheresis. After a 24-month follow-up, 1- and 2-year allograft survivals were 86% and 58%, respectively. C4d became negative in 1 patient posttreatment. Donor-specific antibody (DSA) titers decreased to less than 1:4 in 2 cases. There were 4 infectious complications and 1 case of aseptic meningitis followed by cranial nerve VI palsy. The average hospital charge for 1 administration of IVIG + RTX, including hospital stay and renal biopsy expenses, was approximately $49,000. A combination of IVIG + RTX in late AMR may be beneficial but is an expensive treatment approach for selected renal transplant patients.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Rejeição de Enxerto/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Adulto , Anticorpos/sangue , Anticorpos Monoclonais/economia , Anticorpos Monoclonais Murinos , Biópsia , Efeitos Psicossociais da Doença , Creatinina/sangue , Feminino , Seguimentos , Rejeição de Enxerto/economia , Rejeição de Enxerto/imunologia , Teste de Histocompatibilidade , Humanos , Imunoglobulinas Intravenosas/economia , Imunossupressores/economia , Isoanticorpos/sangue , Transplante de Rim/patologia , Masculino , Pessoa de Meia-Idade , Rituximab , Texas , Adulto JovemRESUMO
Immune globulin intravenous (human) (IGIV) is effective in the treatment of various autoimmune and inflammatory disorders. Recently, high-dose IGIV 2 g/kg has been utilized in the treatment of antibody-mediated rejection in solid organ transplantation. We report a renal transplant recipient who developed aseptic meningitis and diplopia from abducens nerve (cranial nerve VI) palsy following IGIV administration for antibody-mediated rejection. Potential mechanisms of the IGIV-related aseptic meningitis are elaborated. Clinicians should be aware of aseptic meningitis and cranial nerve palsy as an adverse reaction to IGIV exposure and monitor for its signs and symptoms.
Assuntos
Doenças do Nervo Abducente/etiologia , Imunoglobulinas Intravenosas/efeitos adversos , Transplante de Rim , Meningite Asséptica/etiologia , Adulto , Feminino , Rejeição de Enxerto/terapia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Resultado do TratamentoRESUMO
This review describes to date the experience with combined heart-kidney transplant (HNTx) from a single donor. HNTxs are very uncommon relative to single-organ transplants of the heart and kidney, as well as combined kidney-pancreas and combined kidney-liver transplants. Two groups of patients seem to be candidates for HNTx: 1) those with end-stage heart disease and fixed (nonreversible) renal disease, and 2) those with end-stage renal disease and severe cardiac disease unamenable to other treatment. In both groups, significant disease should be limited to the heart and kidney. Reports to date generally suggest decreased cardiac rejection in HNTx relative to heart-only transplants. Renal rejection in HNTx seems markedly reduced relative to kidney-only transplants. Simultaneous rejection of both organs is very uncommon, and, therefore, surveillance of both organs is necessary. Short-term patient survival seems to be acceptable in HNTx. Long-term patient and graft survival remains unknown, and further multi-center reports are needed.
