Caliskan Yasar, Mirioglu Safak, Dirim Ahmet Burak, Ozluk Yasemin, Yegit Ozan, Aksoy Elif, Safak Seda, Guller Nurana, Demir Erol, Artan Ayse Serra, Oto Ozgur Akin, Besisik Sevgi, Yazici Halil, Turkmen Aydin, Lentine Krista L
Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
Division of Nephrology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Ther Apher Dial. 2023 Jun;27(3):428-434. doi: 10.1111/1744-9987.13937. Epub 2022 Oct 14.
We compared the outcomes associated with plasma exchange (PE), double filtration plasmapheresis (DFPP), or immunoadsorption (IA) in the treatment of late antibody mediated rejection (AMR).
Sixty-nine kidney transplantation (KTx) recipients with late AMR were retrospectively categorized according to management with PE (n = 30), DFPP (n = 22) or IA (n = 17). Allograft loss was compared across treatment groups by Kaplan-Meier analysis and Cox regression.
Study groups were similar regarding age, sex, donor type, kidney function, donor specific antibodies, and post-KTx follow-up time. Five-year graft survival trended higher with IA (70.6%) compared to PE (36.7%) and DFPP (27.3%) (p = 0.06). In multivariate Cox regression, baseline eGFR (HR per ml/min/1.73 m [95% CI]; 0.96 [0.94-0.99]), rituximab use (HR [95% CI]; 0.42 [0.21-0.84]), interstitial inflammation (i) (HR [95% CI]; 2.05 [1.13-3.69]), and transplant glomerulopathy (cg) (HR [95% CI]; 1.46 [1.13-1.87]) were associated with graft loss.
These results motivate the need for continued assessment of rituximab and plasmapheresis in larger studies.
我们比较了血浆置换（PE）、双重滤过血浆置换（DFPP）或免疫吸附（IA）治疗晚期抗体介导排斥反应（AMR）的疗效。
69例晚期AMR肾移植（KTx）受者根据治疗方法回顾性分为PE组（n = 30）、DFPP组（n = 22）或IA组（n = 17）。通过Kaplan-Meier分析和Cox回归比较各治疗组的移植物丢失情况。
研究组在年龄、性别、供体类型、肾功能、供体特异性抗体和肾移植后随访时间方面相似。与PE组（36.7%）和DFPP组（27.3%）相比，IA组的5年移植物存活率更高（70.6%）（p = 0.06）。在多变量Cox回归分析中，基线估算肾小球滤过率（eGFR，每毫升/分钟/1.73平方米的风险比[95%置信区间]；0.96 [0.94 - 0.99]）、使用利妥昔单抗（风险比[95%置信区间]；0.42 [0.21 - 0.84]）、间质炎症（i）（风险比[95%置信区间]；2.05 [1.13 - 3.69]）和移植性肾小球病（cg）（风险比[95%置信区间]；1.46 [1.13 - 1.87]）与移植物丢失相关。
这些结果表明需要在更大规模的研究中继续评估利妥昔单抗和血浆置换疗法。
