Immunoadsorption in severe C4d-positive acute kidney allograft rejection:: A randomized controlled trial
Immunoadsorption in severe C4d-positive acute kidney allograft rejection:: A randomized controlled trial
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DOI：
10.1111/j.1600-6143.2006.01613.x
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发表时间：
2007-01-01
影响因子：
8.8
通讯作者：
Druml, W.
中科院分区：
文献类型：
--
作者：
Boehmig, G. A.;Wahrmann, M.;Druml, W.
抗体介导的排斥反应（AMR）经常导致难治性移植物功能障碍。本随机对照试验旨在评价免疫吸附（IA）治疗重度C4d阳性AMR是否有效。756例肾移植受者中有10例入选。患者被随机分配到IA与蛋白A（N = 5）或没有这样的治疗（N = 5）与IA补救3周后的选项。入组的受者接受他克莫司转换，如果有指示，则进行“抗细胞”治疗。所有IA治疗的患者均对治疗有反应。1例与IA无关的死亡发生在成功逆转排斥反应后。4例对照受试者仍依赖透析。除1例发生移植物坏死的患者外，无应答者接受了补救IA，但未成功。由于对照组的移植物丢失率较高，在第一次中期分析后终止了研究。尽管受患者数量较少的限制，但该试验表明IA在逆转重度AMR方面的有效性。
Antibody-mediated rejection (AMR) frequently causes refractory graft dysfunction. This randomized controlled trial was designed to evaluate whether immunoadsorption (IA) is effective in the treatment of severe C4d-positive AMR. Ten out of 756 kidney allograft recipients were included. Patients were randomly assigned to IA with protein A (N = 5) or no such treatment (N = 5) with the option of IA rescue after 3 weeks. Enrolled recipients were subjected to tacrolimus conversion and, if indicated, 'anti-cellular' treatment. All IA-treated patients responded to treatment. One death unrelated to IA occurred after successful reversal of rejection. Four control subjects remained dialysis-dependent. With the exception of one patient who developed graft necrosis, non-responders were subjected to rescue IA, however, without success. Because of a high graft loss rate in the control group the study was terminated after a first interim analysis. Even though limited by small patient numbers, this trial suggests efficiency of IA in reversing severe AMR.