2016 Volume 4 Issue 1 Pages 66-74
The natural history of acute antibody-mediated rejection (AMR) after positive cross-match kidney transplantation involves an acute rise in donor-specific alloantibody (DSA) in the first few weeks after transplantation. The pathogenesis of AMR in several different clinical settings, such as C4d deposition and PTC tis, etc. is becoming clearer and more effective treatments are being developed. Whereas the exact cellular mechanisms responsible for AMR are not known, it seems likely that both pre-existing plasma cells and the conversion of memory B cells to new plasma cells play a role in the increased DSA production. One recent study suggested that combination therapy with plasmapheresis, high-dose IVIG and rituximab was more effective treatment for AMR than high-dose intravenous immunoglobulin (IVIG) alone, but the role of anti-CD20 antibody is still unclear. In this section, we would focus on high dose IVIG therapy which just started in 18 renal transplant recipients with highly sensitization five years ago at our institution. All recipients, except for one case, were successfully transplanted from living donors after complete negative conversion by the treatment of high dose IVIG and combined therapies.
