Intravenous immunoglobulins and rituximab therapy for severe transplant glomerulopathy in chronic antibody-mediated rejection: a pilot study
Intravenous immunoglobulins and rituximab therapy for severe transplant glomerulopathy in chronic antibody-mediated rejection: a pilot study
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DOI：
10.1111/ctr.12535
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发表时间：
2015-05-01
影响因子：
2.1
通讯作者：
Merville, Pierre
中科院分区：
文献类型：
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作者：
Bachelet, Thomas;Nodimar, Celine;Merville, Pierre
移植肾小球病（TG）患者的预后较差。使用B细胞靶向分子代表了在慢性抗体介导的排斥反应期间治疗TG的合理策略。在这项初步研究中，21例诊断为该疾病的患者接受了4剂静脉注射免疫球蛋白和2剂利妥昔单抗（IVIG/RTX组）。他们回顾性地与未经治疗的对照组10例患者进行比较。活检后24个月，治疗组和未治疗组的移植物存活率相似且较差，分别为47%和40%，p=0.69。无论TG的表型如何，均观察到IVIG/RTX治疗无应答。基线估计肾小球滤过率（eGFR）和治疗后前6个月eGFR下降是与24个月移植物存活相关的危险因素。与未治疗组相比，IVIG/RTX治疗对M24时供体特异性同种抗体的动力学有适度的影响，与移植物存活率的改善无关。IVIG/RTX组每例患者的平均不良事件数高于对照组（p=0.03）。总之，IVIG/RTX治疗慢性抗体介导的排斥反应期间的重度TG似乎并没有改变TG的自然史，并且与不良事件的高发生率相关。
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 24months post-biopsy, graft survival was similar and poor between the treated and the untreated group, 47% vs. 40%, respectively, p=0.69. This absence of response of IVIG/RTX treatment was observed, regardless the phenotype of TG. Baseline estimated glomerular filtration rate (eGFR) and decline in eGFR during the first six months after the treatment were risk factors associated with 24-month graft survival. The IVIG/RTX therapy had a modest effect on the kinetics of donor-specific alloantibodies at M24, compared to the untreated group, not associated with an improvement in graft survival. The mean number of adverse events per patient was higher in the IVIG/RTX group than in the control group (p=0.03). Taken together, IVIG/RTX treatment for severe TG during chronic antibody-mediated rejection does not seem to change the natural history of TG and is associated with a high incidence of adverse events.