Clinical effect of rabbit anti-thymocyte globulin for chronic active antibody-mediated rejection after kidney transplantation.

Published on Aug 10, 2021in CEN Case Reports
· DOI :10.1007/S13730-021-00633-7
Ryo Tanaka2
Estimated H-index: 2
,
Koichi Tsutahara7
Estimated H-index: 7
+ 6 AuthorsTetsuya Takao20
Estimated H-index: 20
Sources
Abstract
Chronic active antibody-mediated rejection (CAAMR) is a frequent cause of late graft loss. However, effective treatment for CAAMR after kidney transplantation has not yet been established. Here, we present the case of a kidney transplant recipient who recovered from CAAMR after administration of rabbit anti-thymocyte globulin. A 61-year-old man underwent ABO-compatible living-donor kidney transplantation for end-stage kidney disease; the kidney was donated by his wife. Five years after the transplant, the patient’s serum creatinine level and urine protein-to-creatinine ratio increased. He was subsequently diagnosed with CAAMR based on the kidney allograft biopsy and the presence of donor-specific human leukocyte antigen antibodies. Rabbit anti-thymocyte globulin treatment was administered following steroid pulse therapy. Subsequently, his serum creatinine levels and urine protein to creatinine ratio improved. There was also an improvement in the pathological findings seen on biopsy and the mean fluorescence intensity of donor-specific antibodies. In conclusion, this report describes the case of a kidney transplant recipient who developed CAAMR, treated using rabbit anti-thymocyte globulin. This strategy might be a viable treatment option for CAAMR after a kidney transplant.
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References15
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#1Koji Nanmoku (Jichi Medical University)H-Index: 8
#2Takahiro Shinzato (Jichi Medical University)H-Index: 18
Last. Takashi Yagisawa (Jichi Medical University)H-Index: 17
view all 5 authors...
Abstract Background Rabbit antithymocyte globulin (rATG) induction is associated with reduction in the occurrence of de novo donor-specific antibody (DSA) and antibody-mediated rejection (AMR). Therefore, rATG administration is considered as a treatment for AMR. However, only a few studies have investigated the treatment of AMR with rATG after kidney transplantation. Methods Between April 2013 and March 2018, 162 consecutive de novo kidney transplantations were performed with induction immunosup...
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#1Gastón J PiñeiroH-Index: 7
Last. Fritz DiekmannH-Index: 30
view all 15 authors...
Chronic active antibody-mediated rejection (c-aABMR) is an important cause of allograft failure and graft loss in long-term kidney transplants. To determine the efficacy and safety of combined therapy with rituximab, plasma exchange (PE) and intravenous immunoglobulins (IVIG), a cohort of patients with transplant glomerulopathy (TG) that met criteria of active cABMR, according to BANFF’17 classification, was identified. We identified 62 patients with active c-aABMR and TG (cg ≥ 1). Twenty-three ...
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#1Francesc Moreso (Autonomous University of Barcelona)H-Index: 31
#2Marta CrespoH-Index: 26
Last. Daniel Serón (Autonomous University of Barcelona)H-Index: 16
view all 13 authors...
There are no approved treatments for chronic antibody mediated rejection (ABMR). We conducted a multicenter, prospective, randomized, placebo-controlled, double blind clinical trial to evaluate efficacy and safety of intravenous immunoglobulins (IVIG) combined with rituximab (RTX) (EudraCT 2010-023746-67). Patients with transplant glomerulopathy and anti-HLA donor-specific antibodies (DSA) were eligible. Patients with estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73m2 and/or severe i...
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#1Yasemen Cihan (MHH: Hannover Medical School)H-Index: 1
#2Nele Kanzelmeyer (MHH: Hannover Medical School)H-Index: 11
Last. Lars Pape (MHH: Hannover Medical School)H-Index: 33
view all 10 authors...
Background Chronic antibody-mediated rejection (cAMR) is the leading cause of late kidney graft loss, but current therapies are often ineffective. Rabbit anti-human thymocyte immunoglobulin (rATG) may be helpful, but its use is virtually undocumented.
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#1Julio PascualH-Index: 70
#2Andreas Zuckermann (Medical University of Vienna)H-Index: 46
Last. Maarten Naesens (Katholieke Universiteit Leuven)H-Index: 55
view all 5 authors...
The mode of action of rabbit antithymocyte globulin (rATG) includes preferential inhibition of pre-existing donor-reactive memory T-cell reconstitution and possibly apoptosis of plasma cells, the source of donor specific antibodies (DSAs). In kidney transplant patients with low-strength preformed DSAs, non-comparative data have shown a low incidence of antibody-mediated rejection (ABMR) and graft survival using rATG even without desensitization procedures. For high strengths of preformed DSAs, r...
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#1T. BacheletH-Index: 16
#2Celine Nodimar (University of Bordeaux)H-Index: 1
Last. Pierre Merville (University of Bordeaux)H-Index: 48
view all 9 authors...
Outcome of patients with transplant glomerulopathy (TG) is poor. Using B-cell targeting molecules represent a rational strategy to treat TG during chronic antibody-mediated rejection. In this pilot study, 21 patients with this diagnosis received four doses of intravenous immunoglobulins and two doses of rituximab (IVIG/RTX group). They were retrospectively compared with a untreated control group of 10 patients. At 24 months post-biopsy, graft survival was similar and poor between the treated and...
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#1Heiko Billing (Boston Children's Hospital)H-Index: 16
#2Susanne Rieger (Boston Children's Hospital)H-Index: 8
Last. Burkhard Tönshoff (Boston Children's Hospital)H-Index: 55
view all 7 authors...
Summary Chronic antibody-mediated rejection (AMR) is the major cause of late renal allograft loss. There is, however, no established treatment for this condition. We report the results of a prospective pilot study on an antihumoral therapy (AHT) consisting of high-dose intravenous immunoglobulin G (IVIG) and rituximab in 20 paediatric renal transplant recipients. Donor-specific HLA antibodies (HLA DSA) were quantified by Luminex-based bead array technology. Loss of eGFR decreased significantly f...
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#1Georges Mourad (University of Montpellier)H-Index: 51
#2Emmanuel Morelon (University of Lyon)H-Index: 62
Last. Yvon Lebranchu (François Rabelais University)H-Index: 9
view all 5 authors...
The rabbit antithymocyte globulin Thymoglobulin first became available over 25 yr ago and is the most widely used lymphocyte-depleting preparation in solid organ transplantation. Thymoglobulin targets a wide range of T-cell surface antigens as well as natural killer-cell antigens, B-cell antigens, plasma cell antigens, adhesion molecules and chemokine receptors, resulting in profound, long-lasting T-cell depletion. Randomized studies have established the anti-rejection efficacy of Thymoglobulin ...
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#1Gregor BartelH-Index: 14
#2Elisabeth SchwaigerH-Index: 12
Last. Georg A. BöhmigH-Index: 41
view all 3 authors...
Summary Antibody-mediated rejection (AMR), which is commonly caused by preformed and/or de novo HLA alloantibodies, has evolved as a leading cause of early and late kidney allograft injury. In recent years, effective treatment strategies have been established to counteract the deleterious effects of humoral alloreactivity. One major therapeutic challenge is the barrier of a positive pretransplant lymphocytotoxic crossmatch. Several apheresis- and/or IVIG-based protocols have been shown to enable...
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#1Bertram L. Kasiske (HCMC: Hennepin County Medical Center)H-Index: 104
#2Martin ZeierH-Index: 68
Last. Ethan M Balk (National Kidney Foundation)H-Index: 76
view all 21 authors...
The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of re...
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