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