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Ivig and rejection

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https://www.readbyqxmd.com/read/27894836/use-of-complement-binding-assays-to-assess-the-efficacy-of-antibody-mediated-rejection-therapy-and-prediction-of-graft-survival-in-kidney-transplantation
#1
Daniel S Ramon, Yihung Huang, Lili Zhao, TrisAnn Rendulic, Jeong M Park, Randall S Sung, Milagros Samaniego
BACKGROUND: The Luminex® single antigen bead assay (SAB) is the method of choice for monitoring the treatment for antibody-mediated rejection (AMR). A ⩾50% reduction of the dominant donor-specific antibody (IgG-DSA) mean fluorescence intensity (MFI) has been associated with improved kidney allograft survival, and C1q-fixing DSA activity is associated with poor outcomes in patients with AMR. We aimed to investigate if C1q-DSA can be used as a reliable predictor of response to therapy and allograft survival in patients with biopsy-proven AMR...
November 25, 2016: Human Immunology
https://www.readbyqxmd.com/read/27819032/rituximab-in-combination-with-bortezomib-plasmapheresis-and-high-dose-ivig-to-treat-antibody-mediated-renal-allograft-rejection
#2
Johannes Waiser, Michael Duerr, Constanze Schönemann, Birgit Rudolph, Kaiyin Wu, Fabian Halleck, Klemens Budde, Nils Lachmann
BACKGROUND: Current treatment strategies for antibody-mediated renal allograft rejection (AMR) are not sufficiently effective. In most centers, "standard of care" treatment includes plasmapheresis (PPH) and IVIG preparations. Since several years, modern therapeutics targeting B cells and plasma cells have become available. We investigated, whether combined administration of rituximab and bortezomib in addition to PPH and high-dose IVIG is useful. METHODS: Between November 2011 and January 2013, we treated 10 consecutive patients with biopsy-proven AMR with rituximab (500 mg), bortezomib (4× 1...
August 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27810339/novel-immunotherapeutic-approaches-for-treatment-of-infertility
#3
REVIEW
Samaneh Abdolmohammadi-Vahid, Shahla Danaii, Kobra Hamdi, Farhad Jadidi-Niaragh, Majid Ahmadi, Mehdi Yousefi
One of the most important reasons of infertility and human reproductive failure is related to uncontrolled immunological response of maternal immune system to early embryo or fetus, that cause rejection of this semi-allograft. Therefore, a tolerance in the immune system is essential to modulate the reactions against the fetus to avoid rejection. The immune system imbalance during implantation or pregnancy may lead to implantation failure or miscarriage. So, use of immunosuppressive or immunomodulator agents can be helpful to prevent immunological attack...
October 31, 2016: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/27788792/outcome-of-abo-incompatible-living-donor-renal-transplantations-a-single-center-experience-from-eastern-india
#4
D S Ray, S Thukral
BACKGROUND: With the incessantly increasing number of patients on the waiting list for renal transplants, crossing the blood group barrier can substantially increase the donor pool. We started ABO-incompatible (ABOi) renal transplantation in 2013 with a relatively low-cost preconditioning protocol (additional cost, ∼$1200). This study reports the short-term outcome of ABOi renal transplantations performed at our institution. METHODS: A total of 45 adult ABOi kidney transplant recipients (KTRs) were included in the study...
October 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27758967/intravenous-immune-globulin-stewardship-program-at-a-tertiary-academic-medical-center
#5
Megan A Rocchio, James W Schurr, Aaron P Hussey, Paul M Szumita
BACKGROUND: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women's Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. OBJECTIVE: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. METHODS: This was a prospective, observational study from January 2013 through December 2014...
October 6, 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27542515/repeated-cycles-of-high-dose-intravenous-immunoglobulin-and-plasmapheresis-for-treatment-of-late-antibody-mediated-rejection-of-renal-transplants
#6
Chih-Yuan Lee, Wei-Chou Lin, Ming-Shiou Wu, Ching-Yao Yang, Chi-Chuan Yeh, Meng-Kun Tsai
BACKGROUND/PURPOSE: Intravenous immunoglobulin (IVIG) plays a central role in the treatment of antibody-mediated rejection (AMR) of renal allografts, but the treatment outcomes for late AMR (>6 months after transplantation) are poor. METHODS: We performed a retrospective study to assess the response patterns of IVIG-based (2 g/kg) desensitization for late AMR. Patients who received desensitization after the pathological diagnosis of late AMR positive for complement component C4d were grouped as the Desensitized Group and compared to a historical Control Group with complement component C4d positivity in retrospective stainings...
October 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/27529314/six-year-outcomes-in-broadly-hla-sensitized-living-donor-transplant-recipients-desensitized-with-intravenous-immunoglobulin-and-rituximab
#7
Joseph Kahwaji, Stanley C Jordan, Reiad Najjar, Patarapha Wongsaroj, Jua Choi, Alice Peng, Rafael Villicana, Ashley Vo
BACKGROUND: Desensitization with intravenous immunoglobulin (IVIG) and rituximab can improve transplantation rates in broadly sensitized kidney transplant recipients. However, long-term outcomes are lacking. Here we analyze long-term outcomes in living donor kidney transplant recipients desensitized with this regimen and compare them to low-risk recipients. METHODS: Living donor kidney transplants that took place between July 2006 and December 2010 were considered retrospectively...
August 16, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/27500255/early-and-sustained-reduction-in-donor-specific-antibodies-in-desensitized-living-donor-kidney-transplant-recipients-a-3-year-prospective-study
#8
David Shaffer, Irene D Feurer, Deborah Crowe, Heidi Schaefer
BACKGROUND: Desensitization with IVIG and rituximab allows acceptable graft survival in sensitized kidney transplant recipients with preexisting donor-specific antibodies (DSAs) and a positive crossmatch. There is little published data reporting the durability of DSA removal in kidney transplant recipients treated with IVIG and rituximab. METHODS: We conducted a 3-year prospective DSA monitoring study in living donor kidney recipients with preexisting DSA to assess the durability of DSA removal after a perioperative protocol of IVIG and rituximab...
February 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27496425/human-pooled-immunoglobulin-as-treatment-of-active-antibody-mediated-rejection-of-transplanted-kidney
#9
A Furmańczyk-Zawiska, A Urbanowicz, A Perkowska-Ptasińska, T Bączkowska, A Sadowska, S Nazarewski, A Chmura, M Durlik
BACKGROUND: Antibody-mediated rejection (ABMR) has emerged as the leading cause of renal graft loss. The optimal treatment protocol in ABMR remains unknown. This study aimed to assess the efficacy of intravenous immunoglobulin (IVIG) for treatment of ABMR in renal recipients. METHODS: Thirty-nine ABO-compatible cross-match-negative renal recipients with biopsy-proven ABMR composed the study group. Pulses of methylprednisolone (MP) and appropriate enhancement of net state of immunosuppression were applied in all individuals; 17/39 recipients were administered IVIG (IVIG group); the remaining 22/39 patients, identified to be nonadherent or unsatisfactorily immunosuppressed, were kept on the initial treatment (MP group)...
June 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27495773/safety-and-efficacy-of-alemtuzumab-induction-in-highly-sensitized-pediatric-renal-transplant-recipients
#10
Irene K Kim, Jua Choi, Ashley A Vo, Alexis Kang, Mitasha Patel, Mieko Toyoda, James Mirocha, Elaine S Kamil, J Louis Cohen, Sabrina Louie, Odette Galera, Stanley C Jordan, Dechu P Puliyanda
BACKGROUND: Studies show that alemtuzumab, a potent lymphocyte-depleting agent, is well tolerated in pediatric renal transplantation. We report on the use of alemtuzumab induction in highly HLA sensitized (HS) pediatric kidney transplant patients. METHODS: 50 pediatric renal transplants were performed from 1/2009-12/2014. 15 HS patients received IVIG (2gm/kg x2 doses) /rituximab (375mg/m x1) for desensitization with alemtuzumab induction (15-30mg, 1 dose, subcutaneous), while 35 nonsensitized patients received anti-IL-2R...
August 5, 2016: Transplantation
https://www.readbyqxmd.com/read/27436684/antibody-mediated-rejection-after-abo-incompatible-pediatric-living-donor-liver-transplantation-for-propionic-acidemia-a-case-report
#11
Masaki Honda, Seisuke Sakamoto, Rieko Sakamoto, Shirou Matsumoto, Tomoaki Irie, Koushi Uchida, Keita Shimata, Seiichi Kawabata, Kaori Isono, Shintaro Hayashida, Hidekazu Yamamoto, Fumio Endo, Yukihiro Inomata
We herein present the case of a four-yr-old boy with PA who developed AMR after ABO-incompatible LDLT despite undergoing B cell desensitization using rituximab. Although the CD19+ lymphocyte count decreased to 0.1% nine days after the administration of rituximab, he developed a high fever which was accompanied by arthralgia due to a streptococcal infection 13 days after rituximab prophylaxis. After the clearance of the infection, he underwent ABO-incompatible LDLT 36 days after the administration of rituximab...
September 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/27431753/a-multi-institutional-evaluation-of-antibody-mediated-rejection-utilizing-the-pediatric-heart-transplant-study-database-incidence-therapies-and-outcomes
#12
Philip T Thrush, Elfriede Pahl, David C Naftel, Elizabeth Pruitt, Melanie D Everitt, Heather Missler, Steven Zangwill, Michael Burch, Timothy M Hoffman, Ryan Butts, William T Mahle
BACKGROUND: Current knowledge of antibody-mediated rejection (AMR) after heart transplantation (HT) stems largely from adult data. Using the Pediatric Heart Transplant Study (PHTS) database, we report the incidence of AMR, describe treatment, and evaluate outcomes for treated AMR in children after HT. METHODS: We queried the PHTS database for patients <18 years of age undergoing primary HT between January 2010 and December 2014. An AMR episode was defined as either a biopsy consistent with pathologic AMR or a rejection event based on immunotherapy augmentation directed against antibody production...
June 24, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27265023/inflammation-causes-resistance-to-anti-cd20-mediated-b-cell-depletion
#13
Lindsay H Laws, Clare E Parker, Ganesh Cherala, Yoshinobu Koguchi, Ari Waisman, Mark K Slifka, Martin H Oberbarnscheidt, Jagdeep S Obhrai, Melissa Y Yeung, Leonardo V Riella
B cells play a central role in antibody-mediated rejection and certain auto-immune diseases. However, B-cell-targeted therapy such as anti-CD20 B cell-depleting antibody(aCD20) has yielded mixed results in improving outcomes. In this study, we investigated whether an accelerated B-cell reconstitution leading to aCD20 depletion-resistance could account for these discrepancies. Using a transplantation model, we found that antigen-independent inflammation, likely through TLR signals, was sufficient to mitigate B cell depletion...
June 6, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27234740/progress-in-desensitization-of-the-highly-hla-sensitized-patient
#14
S C Jordan, J Choi, J Kahwaji, A Vo
The presence of HLA antibodies remains a significant and often impenetrable barrier to kidney transplantation, leading to increased morbidity and mortality for patients remaining on long-term dialysis. In recent years, a number of new approaches have been developed to overcome these barriers. Intravenous immunoglobulin (IVIG) remains the lynchpin of HLA desensitization therapy and has been shown in a prospective, randomized, placebo-controlled trial to improve transplantation rates. In addition, IVIG used in low doses with plasma exchange is a reliable protocol for desensitization...
April 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27214874/splenic-irradiation-for-the-treatment-of-severe-antibody-mediated-rejection
#15
B J Orandi, B E Lonze, A Jackson, S Terezakis, E S Kraus, N Alachkar, S M Bagnasco, D L Segev, J B Orens, R A Montgomery
Patients requiring desensitization prior to renal transplantation are at risk for developing severe antibody-mediated rejection (AMR) refractory to treatment with plasmapheresis and intravenous immunoglobulin (PP/IVIg). We have previously reported success at graft salvage, long-term graft survival and protection against transplant glomerulopathy with the use of eculizumab and splenectomy in addition to PP/IVIg. Splenectomy may be an important component of this combination therapy and is itself associated with a marked reduction in donor-specific antibody (DSA) production...
May 23, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27207404/perioperative-desensitization-improves-outcomes-among-crossmatch-positive-recipients-of-deceased-donor-renal-transplants
#16
Amit Sharma, Anne King, Dhiren Kumar, Martha Behnke, Felecia McDougan, Pamela M Kimball
CONTEXT: Graft failure due to chronic rejection is greater among renal transplant patients with donor-specific antibody (DSA) than among DSA-free patients. For patients dependent on deceased donor transplantation, preoperative desensitization to eliminate DSAs may be impractical. We speculated that perioperative desensitization might eliminate preexisting DSAs and prevent de novo DSAs and improve graft outcomes. We report that brief perioperative desensitization using either intravenous immunoglobulin (IVIG) or plasmapheresis/IVIG (PP/IVIG) treatment improves clinical outcomes among patients with positive crossmatches...
June 2016: Progress in Transplantation
https://www.readbyqxmd.com/read/27184779/plasma-derived-c1-esterase-inhibitor-for-acute-antibody-mediated-rejection-following-kidney-transplantation-results-of-a-randomized-double-blind-placebo-controlled-pilot-study
#17
R A Montgomery, B J Orandi, L Racusen, A M Jackson, J M Garonzik-Wang, T Shah, E S Woodle, C Sommerer, D Fitts, K Rockich, P Zhang, M E Uknis
Antibody-mediated rejection (AMR) is typically treated with plasmapheresis (PP) and intravenous immunoglobulin (standard of care; SOC); however, there is an unmet need for more effective therapy. We report a phase 2b, multicenter double-blind randomized placebo-controlled pilot study to evaluate the use of human plasma-derived C1 esterase inhibitor (C1 INH) as add-on therapy to SOC for AMR. Eighteen patients received 20 000 units of C1 INH or placebo (C1 INH n = 9, placebo n = 9) in divided doses every other day for 2 weeks...
May 16, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27109984/intestine-transplantation-across-a-positive-crossmatch-with-preformed-donor-specific-antibodies
#18
R Parekh, M Kazimi, S Skorupski, O Fagoaga, S Jafri, M C Segovia
BACKGROUND: We describe our experience using a modified protocol for immunosuppression for intestine transplantation across a positive crossmatch. Patients who underwent transplantation in 2013 were evaluated over a 12-month period for rejection and infectious events with comparison to procedure-matched controls on our standard protocol of immunosuppression. PATIENTS AND METHODS: We used a modified protocol for intestine and multivisceral transplantation for patients with a positive flow crossmatch...
March 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27073167/successful-transplantation-in-abo-and-hla-incompatible-living-kidney-transplant-patients-a-report-on-12-cases
#19
Lionel Rostaing, Béatrice Karam, Nicolas Congy-Jolivet, Valérie Hage, Federico Sallusto, Laure Esposito, Nicolas Doumerc, Bénédicte Debiol, Céline Guilbeau-Frugier, Xavier Game, Asma Allal, Nassim Kamar
Few studies have assessed the outcomes of ABOi/HLAi living-kidney transplantation. We report a single-center experience of 12 ABOi/HLAi living-kidney recipients. Twenty-seven donor-specific alloantibodies (DSAs) (1-6 per patient) were found with fluorescence intensities of 1500-15 000. Desensitization was based on IVIg, two doses of rituximab (375 mg/m(2) ), tacrolimus-based (0.2 mg/kg) immunosuppression (started on day-10 pretransplant), and 11 (6-27) pretransplant apheresis sessions (plasmapheresis, specific or semi-specific immunoadsorption)...
April 13, 2016: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/27051135/abo-incompatible-renal-transplantation-in-developing-world-crossing-the-immunological-and-mental-barrier
#20
P K Jha, S B Bansal, S K Sethi, M Jain, R Sharma, A Nandwani, M K Phanish, R Duggal, A K Tiwari, P Ghosh, R Ahlawat, V Kher
ABO incompatibility has been considered as an important immunological barrier for renal transplantation. With the advent of effective preconditioning protocols, it is now possible to do renal transplants across ABO barrier. We hereby present a single center retrospective analysis of all consecutive ABOi renal transplants performed from November 2011 to August 2014. Preconditioning protocol consisted of rituximab, plasmapheresis and intravenous immunoglobulin (IVIG) and maintenance immunosuppression consisted of tacrolimus, mycophenolate sodium, and prednisolone...
March 2016: Indian Journal of Nephrology
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