HLA-antibodies monitoring and treatment in renal allograft recipients with antibody-mediated acute rejection

Objective To explore HLA-antibodies monitoring and treatment in renal allograft recipients with antibody-mediated acute rejection(AMR).Methods HLA typing,cross-matching and panel reactive antibody(PRA)monitoring were performed preoperatively.Tacrolimus/cyclosporine,mycophenolate mofetil.and steroids were adopted as immunosuppressants after transplantation in renal allograft recipients.Fifteen cases of AMR occurred 1-14 days post-transplant.Treatments included anti-thymocyte globulin(ATG,100 mg/day × 5-7 days),tacrolimus as a substitute for cyclosporine(if used),plasmapheresis(PP,1-5 sessions)when PRA was increased with occurrence of donor specific antibody(DSA)and intravenous immunoglobulin(IVIG,100-150 mg/kg following each PP,200-500 nag/kg after the last PP session).Results Both HLA class-Ⅰ and class-ⅡDSA were found in 2 patients,only class-Ⅰ DsA in 9 patients,and only class-Ⅱ DSA in 4 patients after transplantation.Rejection episodas were reversed in 14 recipients.One recipient received nephrectomy and second renal transplant at the 10th day post-transplant.Two cases of acute tubular necrosis occurred after anti-rejection treatment and recovered after dialysis for 3-6 weeks.No severe infection complications were observed.During a follow-up period of 12-52 months,one recipient became dialysis-dependent due tO chronic allograft nephropathy 16 months post-transplant,and one recipient died of cardiovascular complications 18 months post-transplant.Renal grafts of other 1 2 recipients functioned well with serum creatinine of 112.5±15.8 μmol/L Conclusion Therapy with ATG plus PP-IVIG is effective and safe for the treatment of AMR. Key words: Kidney transplantation; Graft rejection; Isosantibodies; Plasma exchange; Immunoglobulin