Proactive treatment of angiotensin receptor antibodies in kidney transplantation with plasma exchange and/or candesartan is safe and associated with excellent graft survival at 4â¯years: A single centre Australian experience.
Hum Immunol
; 80(8): 573-578, 2019 Aug.
Article
en En
| MEDLINE
| ID: mdl-31014826
High levels of angiotensin receptor antibodies (ATRab) are associated with acute cellular and humoral rejection, vascular occlusion, de novo human leucocyte antigen donor specific antibody (HLA DSA) and poor graft survival in kidney transplant recipients (KTR). Since 2015 we proactively managed patients "at risk" (AR) with ATRab >17â¯U/ml with perioperative plasma exchange (PLEX) and/or angiotensin receptor blockade (ARB). 44 patients were treated with this protocol. 265 KTR with ATRab ≤17â¯U/ml deemed "low risk" (LR) were transplanted under standard conditions. PLEX and ARB were not associated with increased risk of: delayed graft function requiring haemodialysis (HDx), hyperkalaemia >5.5â¯mmol/l requiring HDx, and the combined clinical end-point of severe hypotension, blood transfusion and re-operation for bleeding. Rejection rates were similar at 90â¯days: 8/44 (18%) in the AR group and 36/265 (14%) in the LR group (pâ¯=â¯0.350). Death censored graft survival was the same between the AR and LR groups with a 94% 48-month graft survival - hazard ratio (log-rank) 1.16 [95% CI 0.2-5.8] pâ¯=â¯0.844. Proactive treatment of ATRab >17â¯U/ml with PLEX and/or ARB is not associated with increased rates of perioperative complications and comparable rates of rejection and death censored graft survival at 4â¯years compared to KTR <17â¯U/ml ATRab.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Intercambio Plasmático
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Autoanticuerpos
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Tetrazoles
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Bencimidazoles
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Receptores de Angiotensina
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Trasplante de Riñón
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Bloqueadores del Receptor Tipo 1 de Angiotensina II
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Rechazo de Injerto
Tipo de estudio:
Guideline
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
/
Middle aged
País/Región como asunto:
Oceania
Idioma:
En
Revista:
Hum Immunol
Año:
2019
Tipo del documento:
Article
Pais de publicación:
Estados Unidos