Successful Treatment of Chronic Antibody-Mediated Rejection With IVIG and Rituximab in Pediatric Renal Transplant Recipients
Successful Treatment of Chronic Antibody-Mediated Rejection With IVIG and Rituximab in Pediatric Renal Transplant Recipients
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DOI：
10.1097/tp.0b013e3181880b35
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发表时间：
2008-11-15
期刊：
影响因子：
6.2
通讯作者：
Toenshoff, Burkhard
中科院分区：
文献类型：
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作者：
Billing, Heiko;Rieger, Susanne;Toenshoff, Burkhard
背景慢性抗体介导的肾移植排斥反应（CAMR）最近被认为是一个明确的疾病分类实体。CAMR的结果很差;这种情况没有既定的治疗方案。因此，我们开始了一项试点研究，对CAMR的治疗与抗体液方案组成的高剂量静脉注射免疫球蛋白（IVIG）和嵌合抗CD 20抗体利妥昔单抗。6名儿童肾移植受者接受了每周4次的IVIG（每次1 g/kg体重），随后在最后一次IVIG输注后1周接受单次利妥昔单抗（375 mg/m2体表面积）。采用Banff'05分类评价移植肾活检。采用平板反应性淋巴细胞毒性试验和固相ELISA法检测人白细胞抗原特异性抗体。干预前6个月的中位肾小球滤过率下降了25（范围，11-26）mL/min/1.73 m2（P
Background. Chronic antibody-mediated rejection (CAMR) of renal allografts has recently been recognized as a defined nosologic entity. The outcome of CAMR is poor; there is no established treatment protocol for this condition. We therefore initiated a pilot study on treatment of CAMR with an antihumoral regimen consisting of high-dose intravenous immunoglobulin (IVIG) and the chimeric anti-CD20 antibody rituximab.Methods. Six pediatric renal transplant recipients with CAMR received four weekly doses of IVIG (1 g/kg body weight per dose), followed by a single dose of rituximab (375 mg/m(2) body surface area) I week after the last IVIG infusion. Renal allograft biopsies were evaluated using the Banff'05 classification. Human leukocyte antigen-specific antibodies were detected by panel-reactive lymphocytotoxicity and solid phase ELISA assays.Results. Median glomerular filtration rate during 6 months before intervention dropped by 25 (range, 11-26) mL/min/1.73 m(2) (P