Introduction:
Chronic active antibody-mediated rejection (ABMR) is a leading cause of long-term graft failure in kidney transplant recipients, characterized by persistent donor-specific antibodies (DSAs) and microvascular inflammation. This study compares the efficacy and safety of intravenous immunoglobulin (IVIG) monotherapy versus plasmapheresis (PLEX) combined with IVIG in managing chronic active ABMR.
Methods:
This retrospective analysis included patients treated with PLEX and IVIG (Group B) and prospectively enrolled patients receiving IVIG monotherapy (Group A). Group A received intravenous methylprednisolone (1 g) and IVIG (2 g/kg) over 4-5 sessions every 2-3 weeks. Group B underwent five sessions of plasmapheresis followed by IVIG as replacement therapy. Clinical outcomes, including serum creatinine, eGFR, and spot urine protein-to-creatinine ratio (UPCR), were assessed at 3 and 6 months post-biopsy. Treatment response was defined as at least a 30% reduction in eGFR within 6 months post-therapy.
Results:
The study included 15 patients: 6 (40%) deceased donor and 9 (60%) living-related transplants. Group A (n=8) showed significant improvements in serum creatinine and eGFR at both 3 and 6 months (p < 0.05). Group B (n=7) exhibited significant improvements at 3 months (p < 0.05), followed by a decline in renal function at 6 months. UPCR changes were not statistically significant in either group. Group B had a higher incidence of infections, with Cytomegalovirus (CMV) diagnosed in 3 patients (42%).
Conclusions:
IVIG monotherapy provides more sustained renal function improvement in chronic active ABMR compared to PLEX combined with IVIG, which is associated with initial benefits but a subsequent decline in renal function and higher infection risk. Further research is warranted to confirm these findings and explore long-term outcomes.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.