ArticleNephro-urology monthly2015
Effectiveness of Intravenous Immunoglobulin Plus Plasmapheresis on Antibody-mediated Rejection or Thrombotic Microangiopathy in Iranian Kidney Transplant Recipient.
Article in Nephro-urology monthly, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed, 2 citations in OpenAlex.
- Characteristics of mismatched eplets affecting de novo donor-specific antibody production and antibody-mediated rejection after kidney transplantation.BMC nephrology · 2025Article
- Role of therapeutic plasma exchange in acute humoral rejection patients undergoing live-related renal transplantation: A single-center experience.Asian journal of transfusion scienceArticle
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntibody mediated rejection (AMR) and thrombotic microangiopathy (TMA) after kidney transplantation are difficult to differentiate most of the times and both play important roles in kidney allograft loss. Common treatment strategies of these two conditions include plasmapheresis, intravenous immunoglobulin (IVIG) and rituximab.
objectivesThis study was designed to assess the efficacy of routine treatment of AMR/TMA in Iranian kidney transplant recipients, which comprises of plasmapheresis and IVIG. PATIENTS AND
methodsThis one-year cross-sectional study was performed in the Kidney Transplantation Ward of Imam-Khomeini Hospital Complex, Tehran, Iran. All kidney transplant recipients who were administered plasmapheresis and IVIG to treat definite or suggested AMR or TMA were assessed clinically and also evaluated on laboratory data.
resultsDuring 2014, we encountered five patients with suspicious AMR or TMA at our kidney transplant center. Renal biopsy was performed for two of them, suggesting AMR for one patient and TMA for another patient. All patients were treated with plasmapheresis plus IVIG. In this center, as a routine practice, the cumulative dose of 2 g/kg of IVIG was divided to 300 - 400 mg/kg after each plasmapheresis. Only one out of the five patients showed response, albeit not completely.
conclusionsDue to daily plasmapheresis within the first several days after AMR or TMA, administering high amounts of the cumulative dose of IVIG after plasmapheresis may result in high amounts of IVIG withdrawal by plasmapheresis and response failure. Our suggestion is to reduce the IVIG dose after each plasmapheresis to 100 mg/kg (i.e. replacement dose) to reach a cumulative dose of 2 g/Kg. If plasmapheresis treatment is initiated sooner than the completion of the IVIG cumulative dose of 2 g/kg, the remaining dose can be administered during one injection.
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