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A clinical audit of kidney transplant recipients with antibody mediated rejection in Southern Tasmania

Citation

Patel, Bansari and Nejatian, A and Skeat, L and Kirkland, G and Jose, M, A clinical audit of kidney transplant recipients with antibody mediated rejection in Southern Tasmania, pp. 79-79. ISSN 1320-5358 (2020) [Conference Extract]


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Abstract

Aim:

To review the diagnosis, management and outcomes of antibody-mediated rejection (AMR) in kidney transplant patients treated with intravenous immunoglobulin (IVIG) in southern Tasmania.

Background:

Accurately diagnosing and treating AMR is crucial to preventing transplant failure and improving long term patient outcomes.

Methods:

This retrospective clinical audit reviewed renal transplant patients with AMR managed by the Royal Hobart Hospital and treated with IVIG between 1/1/2009 and 31/12/2019 using AUDIT4 and Digital Medical Records. AMR was diagnosed as per Banff criteria.

Results:

We identified 25 patients (13 (52%) females), mean age 58 years (range 32-74 years) diagnosed with AMR and treated with IVIG during the study period. HLA mismatches with donor kidney were a mean of 3 MHC class 1 and 1 MHC class 2 mismatches. Patients received between 2 and 22 IVIG treatments at an average dose of 0.53 g/kg each, with up to 20 sessions of plasma exchange (PEX). At 12-months post biopsy, half (46%) of the patients had reduced eGFR (defined as >10% decrease compared to base values at biopsy) after receiving an average of 10.2 IVIG treatments at 0.55 g/kg each and 6.5 PEX at 19 L total volume. The other half (54%) of patients had either stable (within 10% of base values) or improved eGFR (defined as >10% increase compared to base values at biopsy) after receiving an average of 5.8 IVIG treatments at 0.51 g/kg each and 6.6 PEX at 21.8 L total volume. Four (16%) patients experienced IVIG side effects including migraines and nausea.

Conclusion:

Following treatment with IVIG slightly more than half of the patients with AMR showed stabilization or improvement in renal function.

Item Details

Item Type:Conference Extract
Keywords:chronic kidney disease, dialysis, end-stage kidney disease, transplant
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Nephrology and urology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Patel, Bansari (Ms Bansari Patel)
UTAS Author:Nejatian, A (Misc Ava Nejatian)
UTAS Author:Skeat, L (Dr Lee Skeat)
UTAS Author:Kirkland, G (Dr Geoffrey Kirkland)
UTAS Author:Jose, M (Professor Matthew Jose)
ID Code:142067
Year Published:2020
Deposited By:Medicine
Deposited On:2020-12-10
Last Modified:2021-05-21
Downloads:0

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