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논문분류	춘계학술대회 초록집
제목	What’s new in the treatment of chronic antibody mediated rejection?
저자	Byung Ha Chung1,2, Chul Woo Yang1,2
출판정보	2017; 2017(1):
키워드
초록	Circulating alloantibodies are found in a substantial number of renal allograft recipients, and the presence of these alloantibodies is significantly correlated with the development of allograft injury and later graft loss. In renal allograft tissue, chronic injury is represented microscopically as transplant glomerulopathy and diffuse C4d deposition in peritubular capillaries (PTCs); in this regard, it was included as new disease entity named chronic antibody-mediated rejection (CAMR) in the update of the Banff 05 classification. Usually the prognosis of CAMR is poor and conventional immunosuppressants mainly targeting T cell-mediated immunity cannot prevent or reverse it. Therefore, some researchers have suggested that therapies directed at the humoral response may be required for the treatment of CAMR. Recently, some reports have suggested that the combined use of rituximab (RTX) and intravenous immunoglobulin (IVIg) therapy may be useful for the treatment of CAMR. Our center’s previous study also showed that RTX and IVIg combination therapy was effective in delaying the progression of CAMR. We used rituximab and IVIg combination therapy in 18 biopsy proven cAMR patients. After treatment, decline rate of eGFR was significantly slowed down. However, this effect is limited in patients with heavy proteinuria and it had dissipated in all patients by 1 year post-treatment. Recently, new drugs targeting humoral immune system such as bortezomib and eculizumab, has been attempted in treatment of cAMR, but they still lack definitive data in terms of successful treatment of CAMR. It is expected that those therapies will compensate the limitation of previously used anti-humoral therapies in CAMR. References [1] T. Hirai, N. Kohei, K. Omoto, H. Ishida, and K. Tanabe, "Significance of low-level DSA detected by solid-phase assay in association with acute and chronic antibody-mediated rejection," Transplant International, vol. 25, no. 9, pp. 925-934, 2012. [2] J. Pascual, M. J. Perez-Saez, M. Mir, and M. Crespo, "Chronic renal allograft injury: early detection, accurate diagnosis and management," Transplantation Reviews, vol. 26, no. 4, pp. 280-290, 2012. [3] G. Einecke, B. Sis, J. Reeve et al., "Antibody-mediated microcirculation injury is the major cause of late kidney transplant failure," American Journal of Transplantation, vol. 9, no. 11, pp. 2520-2531, 2009. [4] K. Solez, R. B. Colvin, L. C. Racusen et al., "Banff '05 Meeting Report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy ('CAN')," American Journal of Transplantation, vol. 7, no. 3, pp. 518-526, 2007. [5] F. G. Cosio, J. M. Gloor, S. Sethi, and M. D. Stegall, "Transplant glomerulopathy," American Journal of Transplantation, vol. 8, no. 3, pp. 492-496, 2008. [6] S. Mauiyyedi, P. D. Pelle, S. Saidman et al., "Chronic humoral rejection: identification of antibody-mediated chronic renal allograft rejection by C4d deposits in peritubular capillaries," Journal of the American Society of Nephrology, vol. 12, no. 3, pp. 574-582, 2001. [7] P. I. Terasaki and M. Ozawa, "Predictive value of HLA antibodies and serum creatinine in chronic rejection: results of a 2-year prospective trial," Transplantation, vol. 80, no. 9, pp. 1194-1197, 2005. [8] H. Billing, S. Rieger, J. Ovens et al., "Successful treatment of chronic antibody-mediated rejection with IVIG and rituximab in pediatric renal transplant recipients," Transplantation, vol. 86, no. 9, pp. 1214-1221, 2008. [9] H. Billing, S. Rieger, C. Susal et al., "IVIG and rituximab for treatment of chronic antibody mediated rejection: a prospective study in paediatric renal transplantation with a 2-year follow up," Transplant International, vol. 25, no. 11, pp. 1165-1173, 2012. [10] T. Fehr, B. Rusi, A. Fischer, H. Hopfer, R. P. Wuthrich, and A. Gaspert, "Rituximab and intravenous immunoglobulin treatment of chronic antibody-mediated kidney allograft rejection," Transplantation, vol. 87, no. 12, pp. 1837-1841, 2009. [11] Y. A. Hong, H. G. Kim, S. R. Choi et al., "Effectiveness of rituximab and intravenous immunoglobulin therapy in renal transplant recipients with chronic active antibody-mediated rejection," Transplantation Proceedings, vol. 44, no. 1, pp. 182-184, 2012. [12] G.H An, J.T. Yun, Y.A. Hong et al, “The effect of combination therapy with rituximab and intravenous immunoglobulin on the progression of chronic antibody mediated rejection in renal transplant recipients.” Journal of Immunology Research, vol 2014
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