Gubensek Jakob, Buturovic-Ponikvar Jadranka, Kandus Aljosa, Arnol Miha, Lindic Jelka, Kovac Damjan, Rigler Andreja Ales, Romozi Karmen, Ponikvar Rafael
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Ther Apher Dial. 2016 Jun;20(3):240-5. doi: 10.1111/1744-9987.12430.
Antibody-mediated rejection (AMR) is a major cause of kidney graft failure. We aimed to analyze treatment and outcome of AMR in a national cohort of 75 biopsy-proven acute (43 patients, 57%) or chronic active (32 patients, 43%) AMR episodes between 2000 and 2015. The mean patients' age was 46 ± 16 years, the majority was treated with plasma exchange, 4% received immunoadsorption and 7% received both. The majority received pulse methylprednisolone and low-dose CMV hyperimmune globulin, 20% received bortezomib and 13% rituximab. Concomitant infection was treated in 40% of patients. The immediate treatment outcome was successful in 91%, the 1- and 3-year graft survival rates were 71% and 57%, while 3-year patient survival was 97%. Chronic active AMR was associated with worse graft survival than acute AMR (log rank P = 0.06). To conclude, intensive treatment with apheresis and additional immunosuppression was effective in reversing AMR, but long-term graft survival remains markedly decreased, especially in chronic active AMR.
抗体介导的排斥反应（AMR）是肾移植失败的主要原因。我们旨在分析2000年至2015年间全国队列中75例经活检证实的急性（43例患者，57%）或慢性活动性（32例患者，43%）AMR发作的治疗及预后情况。患者的平均年龄为46±16岁，大多数患者接受了血浆置换治疗，4%的患者接受了免疫吸附治疗，7%的患者同时接受了这两种治疗。大多数患者接受了静脉注射甲泼尼龙和低剂量巨细胞病毒高免疫球蛋白治疗，20%的患者接受了硼替佐米治疗，13%的患者接受了利妥昔单抗治疗。40%的患者接受了合并感染的治疗。立即治疗成功率为91%，1年和3年的移植肾存活率分别为71%和57%，而3年的患者存活率为97%。慢性活动性AMR与急性AMR相比，移植肾存活率更低（对数秩检验P = 0.06）。总之，采用血液分离术和额外免疫抑制的强化治疗在逆转AMR方面是有效的，但长期移植肾存活率仍显著降低，尤其是在慢性活动性AMR中。
