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Plasma exchange in renal allograft rejection
The International Journal of Artificial Organs
|July 1, 1983
Summary
Combined plasmapheresis and cyclophosphamide therapy effectively reduced anti-HLA antibodies and improved renal function in kidney transplant patients experiencing acute rejection. Drug therapy alone worsened outcomes.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Circulating anti-HLA antibodies against mismatched donor antigens are implicated in acute kidney transplant rejection.
- Severe vascular lesions on renal biopsy indicate significant rejection episodes.
Purpose of the Study:
- To evaluate the efficacy of combined plasmapheresis and cyclophosphamide versus cyclophosphamide alone in treating acute kidney transplant rejection.
- To assess the impact of these therapies on circulating anti-HLA antibodies and renal function.
Main Methods:
- Seven patients with acute kidney transplant rejection and severe vascular lesions were studied.
- Four patients received combined plasmapheresis and cyclophosphamide therapy.
- Three patients received cyclophosphamide monotherapy.
Main Results:
- Combined therapy led to rapid disappearance of cytotoxic antibodies in 3 of 4 patients, with sustained negativity.
- Cyclophosphamide alone did not alter antibody levels.
- Renal function improved in 3 of 4 patients receiving combined therapy.
- Patients on cyclophosphamide alone experienced rapid renal function decline, requiring renal replacement therapy (RDT) within 2 months.
Conclusions:
- Combined plasmapheresis and cyclophosphamide is a superior treatment for acute kidney transplant rejection associated with anti-HLA antibodies.
- Early intervention with this combined therapy can preserve renal function and potentially prevent graft loss.