Background: Antibody-mediated rejection (AMR) continues to pose a serious challenge in renal transplantation with potentially devastating consequences. Treatment options for this condition include plasmapheresis, high-dose intravenous immunoglobulin (IVIG), plasmapheresis with low-dose IVIG, and the use of rituximab (anti-CD20 chimeric antibody). We previously reported on the short-term outcome of plasmapheresis as a rescue therapy for AMR in our centre. We now report on the long-term follow up.
Methods: Over a 2.5-year study period, 440 cadaveric transplants were performed. AMR developed in 20 (4.5%) patients. Treatment included plasmapheresis and intensification of their immunosuppressive therapy.
Results: Excluding two patients who had infarcted their grafts at diagnosis, 18 patients received plasmapheresis treatment for AMR. Of the 18 patients treated, 14 recovered function, two developed graft infarction within a fortnight of starting plasmapheresis, and two patients were withdrawn from treatment. In the 14 who recovered renal function, graft survival was 86% at 12 months. In this study we report on the 5-year follow-up of these AMR-treatment responders. Eleven patients have a functioning graft at 5 years; graft function was stable with a mean serum creatinine of 130 micromol/L at 5 years compared to 123 mumol/L at 1 year. At 5-years follow-up; graft survival was 78% and patient survival 93%.
Conclusions: Little information is available in the literature regarding the long-term outcome of this therapy. This is the first report on the long-term (5-year) follow-up of plasmapheresis as a rescue therapy for AMR.