Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function...

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Chronic-active antibody mediated rejection (c-aABMR) is a primary cause of long-term kidney transplant failure.
• Effective treatments are crucial to improve allograft survival.

Purpose of the Study:

• To evaluate the efficacy of intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP) for treating patients diagnosed with c-aABMR.
• To assess the impact of this treatment on kidney allograft function and survival.

Main Methods:

• A retrospective analysis included 69 patients diagnosed with c-aABMR between 2005 and 2017.
• Patients received three doses of 1g IV MP combined with a single 1g/kg IVIG dose.
• Treatment response was defined as a post-treatment estimated glomerular filtration rate (eGFR) at least 25% above the projected function.

Main Results:

• The average eGFR decline of 9.8 ml/min/1.73m² pre-treatment significantly reduced to 6.3 ml/min/1.73m² post-treatment (p<0.001).
• A significant improvement in proteinuria (p<0.001) and a considerable slowing of graft function deterioration were observed.
• Sixty-two percent of patients (n=43) were classified as responders, demonstrating significantly superior 3- and 5-year graft survival.

Conclusions:

• Over 60% of patients with c-aABMR and declining eGFR showed a positive response to IVIG-MP therapy.
• This treatment regimen leads to a significant improvement in kidney allograft survival.
• IVIG and MP offer a promising therapeutic option for managing c-aABMR and preserving graft function.