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. 2021 Aug;36(4):584-594.
doi: 10.1002/jca.21897. Epub 2021 Mar 30.

Treatment of antibody-mediated rejection with double-filtration plasmapheresis, low dose IVIg plus rituximab after kidney transplantation

Hamza Naciri Bennani  1 , Mélanie Daligault  1 , Johan Noble  1 , Béatrice Bardy  2 , Lionel Motte  1 , Diane Giovannini  3 , Camille Emprou  3 , Gaëlle Fiard  4   5 , Farida Imerzoukene  1 , Anne Bourdin  2 , Dominique Masson  2 , Bénédicte Janbon  1 , Paolo Malvezzi  1 , Lionel Rostaing  1   5 , Thomas Jouve  1   5
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Treatment of antibody-mediated rejection with double-filtration plasmapheresis, low dose IVIg plus rituximab after kidney transplantation

Hamza Naciri Bennani et al. J Clin Apher. 2021 Aug.

Abstract

Antibody-mediated rejection (ABMR) at early or late post-transplantation remains challenging. We performed a single-center single-arm study where four cases of acute ABMR and nine cases of chronic active ABMR (defined by Banff classification) were treated with double-filtration plasmapheresis (two cycles of three consecutive daily sessions with a 4-day gap between). At the end of the third and sixth DFPP sessions, the patients received rituximab 375 mg/m2 . After a median follow-up of 1078 (61-1676) days, kidney-allograft survival was 50%. Before DFPP/rituximab therapy, the median donor-specific alloantibody (DSA) mean fluorescence intensity (MFI) was 9160 (4000-15 400); 45 days (D45) later it had significantly decreased to 7375 (215-18 100) (P = .018). In addition, at one-year (Y1) post-therapy, MFI had decreased further, that is, 4060 (400-7850) (P = .001). In two patients, DSA MFIs decreased and remained below 2000. The slope of estimated glomerular-filtration rate within the 6 months preceding intervention was -1.18 mL/min/month and remained unchanged at -1.29 mL/min/month within the year after intervention. Proteinuria remained unchanged. Baseline Banff scores on repeat allograft biopsies (post-therapy D45, Y1) did not show any improvement. Side-effects were mild to moderate. We conclude that the combined DFPP/rituximab significantly decreased DSAs in ABMR kidney-transplant recipients but did not improve renal function or renal histology at 1-year follow-up.

Keywords: antibody-mediated rejection; donor-specific alloantibody; double-filtration plasmapheresis; kidney transplantation; rituximab.

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References

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