Treatment with intravenous immunoglobulins and methylprednisolone may significantly decrease loss of renal function in chronic-active antibody-mediated rejection

BackgroundChronic-active antibody mediated rejection (c-aABMR) is a major contributor to long-term kidney allograft loss. We conducted a retrospective analysis to establish the efficacy of treatment with intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP) of patients with c-aABMR.MethodsSixty-nine patients, in the period 2005-2017, with the diagnosis (suspicious for) c-aABMR that were treated with IVIG and MP were included. Patients were administered three doses of 1g intravenous MP combined with a single dose of IVIG (1g/kg body weight). Primary outcome was the decline in allograft function one year post treatment. Responders to IVIG-MP therapy were defined by an eGFR one year after treatment which was at least 25% above the projected allograft function.ResultsPatients showed an average decline in eGFR of 9.8ml/min/1.73m(2) the year prior to treatment. Following treatment, a significant reduction (p<0.001) in eGFR decline was observed (6.3ml/min/1.73m(2)). Furthermore, a significant improvement in proteinuria was observed upon treatment (p<0.001). Sixty-two percent (n=43) of the patients were considered a responder and showed considerable slowing of graft function deterioration in the year after treatment (p<0.001). Three and 5-year graft survival was significantly superior in responders.ConclusionsMore than 60% of patients with c-aABMR with a progressive decline in eGFR respond favorably to treatment with IVIG-MP resulting in a significant improvement of graft survival (Sablik, Am J Transplant 18, 2018).