Ontology highlight
ABSTRACT: Background
At our institution, until April 2013, patients who showed early donor specific anti-HLA antibodies (DSA) after lung transplantation were preemptively treated with therapeutic plasma exchange (tPE) and a single dose of Rituximab. In April 2013, we moved to a therapy based on IgM-enriched human immunoglobulins (IVIG), repeated every 4 weeks, and a single dose of Rituximab.Methods
This observational study was designed to evaluate the short-term patient and graft survival in patients who underwent IVIG-based DSA treatment (group A, n = 57) versus contemporary patients transplanted between April 2013 and January 2015 without DSA (group C, n = 180), as well as to evaluate DSA clearance in IVIG-treated patients versus historic patients who had undergone tPE-based treatment (group B, n = 56). Patient records were retrospectively reviewed. Follow-up ended on April 1, 2015.Results
At 6 months and 1 year of follow-up, group A had a survival similar to group C (P = 0.81) but better than group B (P = 0.008). Group A showed statistically nonsignificant trends toward improved freedom from pulsed-steroid therapy and biopsy-confirmed rejection over groups B and C. The DSA clearance was better in group A than group B at treatment end (92% vs 64%; P = 0.002) and last DSA control (90% vs 75%; P = 0.04).Conclusions
Patients with new early DSA but without graft dysfunction that are treated with IVIG and Rituximab have similarly good early survival as contemporary lung transplant recipients without early DSA. The IVIG yielded increased DSA clearance compared with historic tPE-based treatment, yet spontaneous clearance of new DSA also remains common.
SUBMITTER: Ius F
PROVIDER: S-EPMC5120772 | biostudies-literature | 2016 Dec
REPOSITORIES: biostudies-literature
Ius Fabio F Sommer Wiebke W Kieneke Daniela D Tudorache Igor I Kühn Christian C Avsar Murat M Siemeni Thierry T Salman Jawad J Erdfelder Carolin C Verboom Murielle M Kielstein Jan J Tecklenburg Andreas A Greer Mark M Hallensleben Michael M Blasczyk Rainer R Schwerk Nicolaus N Gottlieb Jens J Welte Tobias T Haverich Axel A Warnecke Gregor G
Transplantation 20161201 12
<h4>Background</h4>At our institution, until April 2013, patients who showed early donor specific anti-HLA antibodies (DSA) after lung transplantation were preemptively treated with therapeutic plasma exchange (tPE) and a single dose of Rituximab. In April 2013, we moved to a therapy based on IgM-enriched human immunoglobulins (IVIG), repeated every 4 weeks, and a single dose of Rituximab.<h4>Methods</h4>This observational study was designed to evaluate the short-term patient and graft survival ...[more]