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Comparison of Combination Plasmapheresis/IVIg/ Anti-CD20 Versus High-Dose IVIg in the Treatment of Antibody-Mediated Rejection
Open accessAbstract
Different strategies appear to improve the success in treatment of antibody-mediated rejection (AMR), although no one best method has yet emerged. The objective of this study was to compare the efficacy of the combination of Plasmapheresis/intravenous immunoglobulin (IVIg)/anti-CD20-based regimes versus high-dose IVIg alone in the treatment of AMR. Group A (12 patients) was treated with high-dose IVIg between January 2000 and December 2003; group B (12 patients) was treated by Plasmapheresis/IVIg/anti-CD20 between January 2004 and December 2005. Graft survival at 36 months was 91.7% in group B versus 50% in group A (p = 0.02). Donor-specific human leukocyte antigens (DSA) levels detected by Luminex single antigen (Luminex SA) and ELISA, 3 months postrejection are significantly lower in group B than in group A: DSA ELISA class 2 score 6-8 (p = 0.02), DSA mean intensity of fluorescence (MFI) max (p = 0.009) and DSA mean MFI (p = 0.0004). The persistence of elevated DSA levels posttreatment is more frequent in patients with graft loss as compared to those with preserved renal function: score 6-8 on ELISA (p = 0.04); mean MFI (p = 0.00009) and MFImax (p = 0.018). We conclude that: (1) high dose IVIg alone is inferior to Plasmapheresis/IVIg/anti-CD20 as therapy for AMR and (2)DSA postrejection can be quantified using solid phase assays, showing that 3 months after AMR, DSA levels are higher in patients with graft loss.
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Cited by
Complement-Binding Anti-HLA Antibodies and Kidney-Allograft Survival
Loupy, A., Lefaucheur, C., Vernerey, D., Prugger, C., van Huyen, J.-P. D., Mooney, N., Suberbielle, C., Frémeaux-Bacchi, V., Méjean, A., Desgrandchamps, F., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1302506 · Cited by 852
Self-citationTait, B. D., Süsal, C., Gebel, H. M., Nickerson, P. W., Zachary, A. A., Claas, F. H. J., Reed, E. F., Bray, R. A., Campbell, P., Chapman, J. R., et al. (2013) · Transplantation · doi:10.1097/tp.0b013e31827a19cc · Cited by 787
Self-citationSzczepiorkowski, Z. M., Winters, J. L., Bandarenko, N., Kim, H. C., Linenberger, M. L., Marques, M. B., Sarode, R., Schwartz, J., Weinstein, R., & Shaz, B. H. (2010) · Journal of Clinical Apheresis · doi:10.1002/jca.20240 · Cited by 508
Baker, R. J., Mark, P. B., Patel, R. K., Stevens, K. K., & Palmer, N. (2017) · BMC Nephrology · doi:10.1186/s12882-017-0553-2 · Cited by 211
Effector Mechanisms of Rejection
Moreau, A., Varey, E., Anegon, I., & Cuturi, M.-C. (2013) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a015461 · Cited by 189
Metadata
- Authors
- Lefaucheur, C., Nochy, D., Andrade, J., Verine, J., Gautreau, C., Charron, D., Hill, G. S., Glotz, D., & Suberbielle-Boissel, C.
- Venue
- American Journal of Transplantation
- Publisher
- Elsevier BV
- Published
- 2009-05
- Volume
- 9
- Issue
- 5
- Pages
- 1099-1107
- ISSN
- 1600-6135 (ISSN-L)
- OpenAlex
- W2061888899
- Cited by
- 291
- References
- 0
- FWCI
- 12.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
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- Lefaucheur, C., Nochy, D., Andrade, J., Verine, J., Gautreau, C., Charron, D., Hill, G. S., Glotz, D., & Suberbielle-Boissel, C. (2009). Comparison of Combination Plasmapheresis/IVIg/ Anti-CD20 Versus High-Dose IVIg in the Treatment of Antibody-Mediated Rejection. American Journal of Transplantation. https://doi.org/10.1111/j.1600-6143.2009.02591.x
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