Treatment of Acute Antibody-Mediated Rejection in Children Post-Kidney Transplantation: A Single Center’s Experience
Kidney transplantation has significantly changed the quality of
life of patients with advanced chronic kidney disease.
Unfortunately, renal allografts have a finite longevity; this is despite
significant advancements in post-renal transplant management.
Long-term graft survival is often impacted by events such as rejection,
recurrence of original disease, immunosuppression toxicity,
non-adherence to antirejection therapy, and opportunistic infections.
The incidence of acute antibody-mediated rejection
in pediatric renal transplant recipients has not been well defined.
This form of rejection is responsible for approximately
35.6% of renal allograft loss.
Histopathologic diagnostic criteria for aAMR have been recently redefined.
Currently, there has not been a collective approach to the management of patients with aAMR.
Previously reported therapies to treat aAMR included: escalation of maintenance
immunosuppressive agents, pulse methylprednisolone, intravenous gamma globulin
to neutralize pathogenic circulating antibodies, rituximab to deplete B-lymphocytes,
rabbit antithymoglobulin to deplete T-cells, bortezomib to destroy mature plasma cells,
apheresis to temporarily remove circulating antibodies, and recently eculizumab
to block terminal complement pathway.
Secondary endpoints involved iDSAs response and treatment
complications. Serum creatinine and serum iDSAs levels were
monitored periodically to determine the response to treatment.
Baseline serum creatinine level to calculate eGFR was
arbitrarily defined as the lowest serum creatinine level during
the last three months before the aAMR event.
Nephrol Open J. 2021; 6(1): 8-15 doi: 10.17140/NPOJ-6-125