Therapeutic efficacy of plasmapheresis and intravenous immunoglobulin plus Rituximab for antibody-mediated rejection after kidney transplantation

Abstract

Objective To compare the therapeutic efficacy of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) plus Rituximab for antibody-mediated rejection (AMR) after kidney transplantation. Methods From May 2015 to November 2018, a single-center retrospective cohort study was conducted for 540 recipients with high-resolution HLA undergoing kidney transplantation. According to the criteria of diagnosing AMR and patient selection, 20 patients were selected for PP+ IVIG (group A, n=12), PP+ IVIG+ Rituximab (group B, n=8). The efficacies and outcomes of two groups were compared. Results During a follow-up period of (12.0±5.8) months, no significant inter-group differences existed in basic profiles (P>0.05). After AMR treatment, serum creatinine levels decreased significantly from 283.4 to 226.4 μmol/L in group A (P=0.001) and from 289.4 to 166.6 μmol/L in group B (P=0.049). And the magnitude of decline was more marked in group B (P=0.023). Meanwhile, antibody MFI (log10) decreased from 3.73 to 3.62 in group A (P=0.012) and from 3.57 to 3.02 in group B (P=0.043). At months 3 and 6, serum creatinine level was lower in group B than that in group A (125.0 vs. 166.1 μmol/L, P=0.03; 127.0 vs. 169.0 μmol/L, P=0.048). The serum creatinine levels of AMR patients were 249.8 and 233.8 μmol/L respectively (P=0.182). Serum creatinine levels were 176.1 and 120.3 μmol/L (P=0.045) and 180.2 and 114.8 μmol/L at months 3 and 6 (P=0.044) respectively. Serum creatinine levels were 202.8 and 122.5 μmol/L (P=0.049) in group A and 142.7 and 107.0 μmol/L (P=0.046) in group B respectively. Four recipients developed allograft failure. At month 6 post-operation, AMR occurred in group A (n=3, 25%) and group B (n=1, 12.5%). And the incidence of leucopenia was 37.5% and 0 (P=0.049) in groups A and B respectively. Conclusions PP and IVIG plus rituximab is more efficacious for AMR. The earlier occurring time, the better prognosis. Key words: Kidney transplantation; Antibody-mediated rejection; Plasmapheresis; Intravenous immunoglobulin; Rituximab