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https://www.readbyqxmd.com/read/29053910/a-simplified-protocol-using-rituximab-and-immunoglobulin-for-abo-incompatible-low-titre-living-donor-liver-transplantation
#1
Seong Hoon Kim, Eung Chang Lee, Jae Ryong Shim, Sang Jae Park
BACKGROUND & AIMS: No consensus has been reached regarding optimal treatment strategies for ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). We introduce a simplified protocol using rituximab and intravenous immunoglobulin (IVIG). METHODS: Data were analysed on adult patients who underwent ABO-I LDLT of which protocol added rituximab (300 mg/m(2) ) before surgery and IVIG (0.8 g/kg) on post-operative days 1 and 4 to the conventional immunosuppressive regimen used in ABO-compatible (ABO-C) LDLT, without plasmapheresis, splenectomy or graft local infusion...
October 20, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28949089/treatment-of-chronic-antibody-mediated-rejection-with-intravenous-immunoglobulins-and-rituximab-a-multicenter-prospective-randomized-double-blind-clinical-trial
#2
Francesc Moreso, Marta Crespo, Juan C Ruiz, Armando Torres, Alex Gutierrez-Dalmau, Antonio Osuna, Manel Perelló, Julio Pascual, Irina B Torres, Dolores Redondo-Pachón, Emilio Rodrigo, Marcos Lopez-Hoyos, Daniel Seron
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 per 1.73m(2) and/or severe interstitial fibrosis/tubular atrophy were excluded...
September 26, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28929636/risk-factors-for-the-development-of-antibody-mediated-rejection-in-highly-sensitized-pediatric-kidney-transplant-recipients
#3
Irene K Kim, Jua Choi, Ashley Vo, Alexis Kang, Justin Steggerda, Sabrina Louie, Mark Haas, James Mirocha, J Louis Cohen, Helen Pizzo, Elaine S Kamil, Stanley C Jordan, Dechu Puliyanda
ABMR remains a significant concern for early graft loss, especially for those who are HS against HLA antigens. We sought to determine the risk factors leading to ABMR in HS pediatric kidney transplant recipients. From January 2009 to December 2015, 16 HS pediatric kidney transplant patients at our center (age range 2-21) were retrospectively reviewed for outcomes and risk factors for ABMR. All HS patients received desensitization with high-dose IVIG/rituximab prior to transplant. Two groups were examined: ABMR(+) (n = 7) and ABMR(-) (n = 9)...
September 19, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28775248/clinical-outcome-of-rituximab-and-intravenous-immunoglobulin-combination-therapy-in-kidney-transplant-recipients-with-chronic-active-antibody-mediated-rejection
#4
Tae Hyun Ban, Ji Hyun Yu, Byung Ha Chung, Bum Soon Choi, Cheol Whee Park, Yong-Soo Kim, Chul Woo Yang
BACKGROUND We previously reported that rituximab (RIT) and intravenous immunoglobulin (IVIg) combination therapy is effective in deterring the progression of chronic active antibody-mediated rejection (CAMR), but that report was based on the assessment of a small number of cases for a short period. MATERIAL AND METHODS Forty-three patients with CAMR were recruited during the study period after 2010. The patients were divided into high (n=17, 39.5%) and low proteinuria groups (n=26, 60.5%) based on spot urine protein-to-creatinine ratio of > or <3...
August 4, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28736013/outcomes-of-highly-sensitized-patients-undergoing-simultaneous-liver-and-kidney-transplantation-a-single-center-experience-with-desensitization
#5
J A Steggerda, A Kang, S-H Pan, V Sundaram, N N Nissen, A S Klein, T Todo, A Annamalai, A Vo, S C Jordan, I K Kim
BACKGROUND: Preformed donor-specific human leukocyte antigen antibodies (DSAs) in patients undergoing simultaneous liver and kidney transplantation (SLKT) are an independent risk factor for poorer patient and renal allograft survival. The outcomes of patients highly sensitized (HS) against HLA antigens undergoing SLKT and select HS SLKT recipients undergoing desensitization at a high-volume desensitization center were investigated. METHODS: Seventy-five patients undergoing SLKT at a high-volume desensitization center between January 1, 2001, and December 31, 2015, were retrospectively reviewed...
July 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28658148/graft-versus-host-disease-after-kidney-transplantation-a-case-report-and-literature-review
#6
REVIEW
Yanhua Guo, Shouyang Ding, Hui Guo, Shenqiu Li, Xia Lu, Zhishui Chen, Zhonghua Klaus Chen, Changsheng Ming, Nianqiao Gong
INTRODUCTION: Acute graft-versus-host-disease (GVHD) in kidney recipients is extremely rare. Knowledge about its clinical manifestations, diagnosis, treatment, and prognosis is limited and needs to be increased. CLINICAL FINDINGS: One male kidney transplant recipient developed diarrhea and suffered kidney function damage. Primarily diagnosed with acute rejection, he was given methylprednisolone (MP) bolus treatment. Meanwhile, intravenous immunoglobulin (IVIG) and decreased immunosuppressive agents were applied for the corresponding infection...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28654684/intravenous-immunoglobulin-therapy-in-kidney-transplant-recipients-with-de-novo-dsa-results-of-an-observational-study
#7
Marie Matignon, Caroline Pilon, Morgane Commereuc, Cynthia Grondin, Claire Leibler, Tomek Kofman, Vincent Audard, José Cohen, Florence Canoui-Poitrine, Philippe Grimbert
BACKGROUND: Approximately 25% of kidney transplant recipients develop de novo anti-HLA donor-specific antibodies (dnDSA) leading to acute antibody-mediated rejection (ABMR) in 30% of patients. Preemptive therapeutic strategies are not available. METHODS: We conducted a prospective observational study including 11 kidney transplant recipients. Inclusion criteria were dnDSA occurring within the first year after transplant and normal allograft biopsy. All patients were treated with high-dose IVIG (2 g/kg 0, 1 and 2 months post-dnDSA)...
2017: PloS One
https://www.readbyqxmd.com/read/28640458/long-term-graft-survival-in-patients-with-chronic-antibody-mediated-rejection-with-persistent-peritubular-capillaritis-treated-with-intravenous-immunoglobulin-and-rituximab
#8
William R Mulley, Louis L Huang, Sharmila Ramessur Chandran, Anthony Longano, Liv A R Amos, Kevan R Polkinghorne, David J Nikolic-Paterson, John Kanellis
Chronic antibody-mediated rejection (cAMR) is the major cause of premature renal allograft loss and is resistant to therapy with 12-month graft failure of up to 50% reported. We examined the duration of graft survival and associates of graft failure in patients with donor-specific antibody-positive cAMR and treatment-resistant peritubular capillaritis between June 2007 and October 2010. Those with advanced interstitial fibrosis (n=5) were excluded. Included patients (n=24) received treatment with high-dose intravenous immunoglobulin and fixed-dose rituximab (500 mg)...
September 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28620559/ivig-associated-aseptic-meningitis-in-a-renal-transplant-patient
#9
Tamara Wanigasekera, Rachel J Grainger, Donal J Sexton, Colm Magee
The management of antibody-mediated rejection in renal transplant recipients involves plasmapheresis with IVIG. Aseptic meningitis is a rare adverse effect of IVIG therapy and is a diagnosis of exclusion. We report a case of a renal transplant patient who developed IVIG associated aseptic meningitis in the context of management of antibody-mediated rejection, four years after transplantation.
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28551928/-abo-incompatible-kidney-transplantation
#10
Sigal Eisner, Jacob Orlin, Eviatar Nesher, Vadym Mazhybovsky, Michael Gurevich, Rachel Michowiz, Ruth Rahamimov, Eytan Mor
INTRODUCTION: With the introduction of new therapies, the ABO barrier for kidney transplantation has been breached. In the recent decade the reported results with ABO incompatible (ABOi) kidney transplantation are similar to ABO compatible transplantation. We report on our initial experience with ABOi kidney transplantation performed at the Rabin Medical Center. METHODS: During the period 3/2010 to 4/2015, 22 patients with PRA 0% underwent ABOi living-donor kidney transplantation...
April 2017: Harefuah
https://www.readbyqxmd.com/read/28476933/nature-and-clonality-of-the-fluoresceinated-secondary-antibody-in-luminex-multiplex-bead-assays-are-critical-factors-for-reliable-monitoring-of-serum-hla-antibody-levels-in-patients-for-donor-organ-selection-desensitization-therapy-and-assessment-of-the-risk
#11
Mepur H Ravindranath, Vadim Jucaud, Nubia Banuelos, Matthew J Everly, Junchao Cai, Anh Nguyen, Paul I Terasaki
Luminex multiplex immunoassays enable simultaneous monitoring of Abs against multiple Ags in autoimmune, inflammatory, and infectious diseases. The assays are used extensively to monitor anti-HLA Abs in transplant patients for donor organ selection, desensitization, and assessing the risk for graft rejection. To monitor IgG Abs, fluoresceinated IgG constant H chain-binding polyclonal F(ab')2 (IgHPolyFab) is used as the fluoresceinated secondary Ab (2nd-Ab), whereas IgG subclasses are monitored with Fc-specific monoclonal whole IgG (FcMonoIgG)...
June 1, 2017: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/28360016/fc%C3%AE-riib-expression-on-b-cells-is-associated-with-treatment-efficacy-for-acute-rejection-after-kidney-transplantation
#12
Juan Jin, Jianguang Gong, Bo Lin, Yiwen Li, Qiang He
BACKGROUND: Fcγ receptors (FcγR) play a role in the acute rejection (AR) of organ transplants. FcγRIIB is an inhibitory FcγR expressed on B cells. Intravenous IgG (IVIG) and CD28 monoclonal antibody (mAb) have been shown to have immunomodulatory properties against AR. AIM: To examine the association between FcγRIIB expression on B cell subpopulations and AR treatment efficacy. METHODS: Male F344 rats were used as kidney donors and Lewis rats as recipients to establish models of renal transplantation...
May 2017: Molecular Immunology
https://www.readbyqxmd.com/read/28348361/the-impact-of-donor-specific-anti-human-leukocyte-antigen-hla-antibody-rebound-on-the-risk-of-antibody-mediated-rejection-in-sensitized-kidney-transplant-recipients
#13
Kyo Won Lee, Jae Berm Park, Chan Woo Cho, Nuri Lee, Heejin Yoo, Kyunga Kim, Hyojun Park, Eun Suk Kang, Wooseong Huh, Sungjoo Kim
BACKGROUND Donor-specific anti-HLA antibody (DSA) detected on Luminex-based single antigen assay (LSA) has become the subject of desensitization based upon the results of previous studies. We retrospectively investigated the impact of preoperative DSA on the incidence of antibody mediated rejection (AMR) in patients desensitized using a protocol based on rituximab and rabbit antithymocyte globulin (rATG). MATERIAL AND METHODS Nine patients (Group 1, 9/327, 2.8%) were complement dependent cytotoxicity crossmatch (CDC-XM) positive and underwent desensitization with rituximab (375 mg/m²), intravenous immunoglobulin (IVIG; 400 mg/kg), plasmapheresis, and rATG...
March 28, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28331448/antibody-mediated-rejection-a-review
#14
Jorge Carlos Garces, Sixto Giusti, Catherine Staffeld-Coit, Humberto Bohorquez, Ari J Cohen, George E Loss
BACKGROUND: Chronic antibody injury is a serious threat to allograft outcomes and is therefore the center of active research. In the continuum of allograft rejection, the development of antibodies plays a critical role. In recent years, an increased recognition of molecular and histologic changes has provided a better understanding of antibody-mediated rejection (AMR), as well as potential therapeutic interventions. However, several pathways are still unknown, which accounts for the lack of efficacy of some of the currently available agents that are used to treat rejection...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28265581/impact-of-desensitization-on-antiviral-immunity-in-hla-sensitized-kidney-transplant-recipients
#15
Mieko Toyoda, Bong-Ha Shin, Shili Ge, James Mirocha, David Thomas, Maggie Chu, Edgar Rodriguez, Christine Chao, Anna Petrosyan, Odette A Galera, Ashley Vo, Jua Choi, Alice Peng, Joseph Kahwaji, Stanley C Jordan
Viral infections represent significant morbidity and mortality factors in kidney transplant recipients, with CMV, EBV, and BKV infections being most common. Desensitization (DES) with IVIg and rituximab with/without plasma exchange followed by kidney transplantation with alemtuzumab induction increased successful transplant rates in HLA-sensitized patients but may represent an increased risk for viral infections due to severe lymphocyte depletion. Here, we report on the posttransplant viral infection status in 372 DES versus 538 non-DES patients...
2017: Journal of Immunology Research
https://www.readbyqxmd.com/read/28255562/treatment-of-antibody-mediated-renal-allograft-rejection-improving-step-by-step
#16
Nils Lachmann, Michael Duerr, Constanze Schönemann, Axel Pruß, Klemens Budde, Johannes Waiser
Throughout the past years we stepwise modified our immunosuppressive treatment regimen for patients with antibody-mediated rejection (ABMR). Here, we describe three consecutive groups treated with different regimens. From 2005 until 2008, we treated all patients with biopsy-proven ABMR with rituximab (500 mg), low-dose (30 g) intravenous immunoglobulins (IVIG), and plasmapheresis (PPH, 6x) (group RLP, n = 12). Between 2009 and June 2010, patients received bortezomib (1.3 mg/m(2), 4x) together with low-dose IVIG and PPH (group BLP, n = 11)...
2017: Journal of Immunology Research
https://www.readbyqxmd.com/read/28199785/assessment-of-tocilizumab-anti-interleukin-6-receptor-monoclonal-as-a-potential-treatment-for-chronic-antibody-mediated-rejection-and-transplant-glomerulopathy-in-hla-sensitized-renal-allograft-recipients
#17
J Choi, O Aubert, A Vo, A Loupy, M Haas, D Puliyanda, I Kim, S Louie, A Kang, A Peng, J Kahwaji, N Reinsmoen, M Toyoda, S C Jordan
Extending the functional integrity of renal allografts is the primary goal of transplant medicine. The development of donor-specific antibodies (DSAs) posttransplantation leads to chronic active antibody-mediated rejection (cAMR) and transplant glomerulopathy (TG), resulting in the majority of graft losses that occur in the United States. This reduces the quality and length of life for patients and increases cost. There are no approved treatments for cAMR. Evidence suggests the proinflammatory cytokine interleukin 6 (IL-6) may play an important role in DSA generation and cAMR...
September 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28131494/immunomodulation-by-hyperimmunoglobulins-after-solid-organ-transplantation-beyond-prevention-of-viral-infection
#18
REVIEW
Rogier van Gent, Herold J Metselaar, Jaap Kwekkeboom
Hyperimmunoglobulins are pharmaceutical formulations of human IgG which contain high titers of antibodies against specific viruses. They have been successfully used in solid organ transplantation (SOT) to prevent Cytomegalovirus (CMV) and Hepatitis B Virus (HBV) infection. The introduction of effective and cheaper antiviral drugs has resulted in decreasing usage of hyperimmunoglobulins in SOT. However, it may still be attractive to combine antiviral drug therapy with hyperimmunoglobulins after SOT, as there is some evidence that hyperimmunoglobulins, similar to high doses of intravenous immunoglobulins (IVIgs), might exert anti-inflammatory activity and thereby prevent immunological graft damage and improve graft and patient survival...
April 2017: Transplantation Reviews
https://www.readbyqxmd.com/read/28114171/long-term-outcomes-of-kidney-transplantation-in-patients-with-high-levels-of-preformed-dsa-the-necker-high-risk-transplant-program
#19
Lucile Amrouche, Olivier Aubert, Caroline Suberbielle, Marion Rabant, Jean-Paul Duong Van Huyen, Frank Martinez, Rebecca Sberro-Soussan, Anne Scemla, Claire Tinel, Renaud Snanoudj, Julien Zuber, Ruy Cavalcanti, Marc-Olivier Timsit, Lionel Lamhaut, Dany Anglicheau, Alexandre Loupy, Christophe Legendre
BACKGROUND: There is an increasing number of anti-HLA sensitized and highly sensitized renal transplant candidates on waiting lists, and the presence of donor-specific alloantibodies (DSAs) at the time of transplantation leads to acute and chronic antibody-mediated rejection (AMR). Acceptable short-term outcomes have been described, notably because of desensitization protocols, but mid- and long-term data are still required. METHODS: Our high immunologic risk program included 95 patients with high peak or day 0 DSA levels (mean fluorescence intensity [MFI] > 3000) with a complement-dependent cytotoxicity-negative crossmatch, who received a posttransplant desensitization protocol starting at day 0 with high-dose intravenous immunoglobulin, plasma exchanges, and eventually rituximab...
October 2017: Transplantation
https://www.readbyqxmd.com/read/28009783/treatment-of-acute-antibody-mediated-renal-allograft-rejection-with-cyclophosphamide
#20
Johannes Waiser, Michael Duerr, Klemens Budde, Birgit Rudolph, Kaiyin Wu, Friederike Bachmann, Fabian Halleck, Constanze Schönemann, Nils Lachmann
BACKGROUND: Antibody-mediated rejection (AMR) is a major risk for renal allograft survival. Throughout decades, cyclophosphamide treatment has been proven to be effective in patients with antibody-associated autoimmune diseases. We investigated whether cyclophosphamide combined with plasmapheresis and intravenous immunoglobulins is an option for patients with AMR. METHODS: Between March 2013 and November 2015, we initiated treatment of 13 consecutive patients with biopsy-proven acute AMR with intravenous cyclophosphamide pulses (15 mg/kg adapted to age and renal function) at 3-week intervals, PPH (6×), and high-dose intravenous immunoglobulin (1...
October 2017: Transplantation
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