PMID- 27542515
OWN - NLM
STAT- MEDLINE
DCOM- 20170818
LR  - 20170818
IS  - 0929-6646 (Print)
IS  - 0929-6646 (Linking)
VI  - 115
IP  - 10
DP  - 2016 Oct
TI  - Repeated cycles of high-dose intravenous immunoglobulin and plasmapheresis for 
      treatment of late antibody-mediated rejection of renal transplants.
PG  - 845-852
LID - S0929-6646(16)30149-8 [pii]
LID - 10.1016/j.jfma.2016.07.007 [doi]
AB  - 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. RESULTS: The 10-year graft survival of the Desensitized 
      Group (73.9%, n = 35) was significantly better than that of the historical 
      Control Group (35.0%, n = 40) without desensitization. In the Desensitized Group, 
      a subgroup of patients (D2 Subgroup, n = 11), who responded to desensitization 
      initially but deteriorated later, was identified to benefit from repeated cycles 
      of desensitization at 31.1 +/- 20.9 months. Patients receiving only one cycle of 
      desensitization were further grouped into D1-good (n = 10) and D1-poor (n = 14) 
      based on their long-term renal function. The D2 Subgroup patients did not exhibit 
      significant improvements in renal function compared to the D1-poor patients, 
      until 30 months after IVIG-based desensitization, suggesting desensitization 
      therapy has a working window of approximately 24 months. CONCLUSION: Repeated 
      cycles of IVIG-based desensitization help stabilize long-term renal function in 
      patients with persistent AMR.
CI  - Copyright (c) 2016. Published by Elsevier B.V.
FAU - Lee, Chih-Yuan
AU  - Lee CY
AD  - Department of Surgery, National Taiwan University Hospital and National Taiwan 
      University, College of Medicine, Taipei, Taiwan.
FAU - Lin, Wei-Chou
AU  - Lin WC
AD  - Department of Pathology, National Taiwan University Hospital and National Taiwan 
      University, College of Medicine, Taipei, Taiwan.
FAU - Wu, Ming-Shiou
AU  - Wu MS
AD  - Department of Internal Medicine, National Taiwan University Hospital and National 
      Taiwan University, College of Medicine, Taipei, Taiwan.
FAU - Yang, Ching-Yao
AU  - Yang CY
AD  - Department of Surgery, National Taiwan University Hospital and National Taiwan 
      University, College of Medicine, Taipei, Taiwan.
FAU - Yeh, Chi-Chuan
AU  - Yeh CC
AD  - Department of Surgery, National Taiwan University Hospital and National Taiwan 
      University, College of Medicine, Taipei, Taiwan.
FAU - Tsai, Meng-Kun
AU  - Tsai MK
AD  - Department of Surgery, National Taiwan University Hospital and National Taiwan 
      University, College of Medicine, Taipei, Taiwan. Electronic address: 
      mengkuntsai@ntu.edu.tw.
LA  - eng
PT  - Journal Article
DEP - 20160816
PL  - Singapore
TA  - J Formos Med Assoc
JT  - Journal of the Formosan Medical Association = Taiwan yi zhi
JID - 9214933
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Peptide Fragments)
RN  - 80295-50-7 (Complement C4b)
RN  - 80295-52-9 (complement C4d)
SB  - IM
MH  - Adult
MH  - Complement C4b/analysis
MH  - *Desensitization, Immunologic
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Graft Rejection/*therapy
MH  - Graft Survival
MH  - Humans
MH  - Immunoglobulins, Intravenous/*administration & dosage
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Kaplan-Meier Estimate
MH  - Kidney Transplantation/*adverse effects/mortality
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Peptide Fragments/analysis
MH  - *Plasmapheresis
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Taiwan
MH  - Treatment Outcome
OTO - NOTNLM
OT  - antibody-mediated rejection
OT  - complement component C4d
OT  - intravenous immunoglobulin
OT  - renal function
EDAT- 2016/08/21 06:00
MHDA- 2017/08/19 06:00
CRDT- 2016/08/21 06:00
PHST- 2016/04/21 00:00 [received]
PHST- 2016/07/05 00:00 [revised]
PHST- 2016/07/05 00:00 [accepted]
PHST- 2016/08/21 06:00 [pubmed]
PHST- 2017/08/19 06:00 [medline]
PHST- 2016/08/21 06:00 [entrez]
AID - S0929-6646(16)30149-8 [pii]
AID - 10.1016/j.jfma.2016.07.007 [doi]
PST - ppublish
SO  - J Formos Med Assoc. 2016 Oct;115(10):845-852. doi: 10.1016/j.jfma.2016.07.007. 
      Epub 2016 Aug 16.