Lack of Efficacy and Safety of Eculizumab for Treatment of Antibody-Mediated Rejection Following Renal Transplantation |
| |
| Institution: | 1. Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea;2. Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea;3. Renal Pathology, Department of Pathology, Brigham & Women''s Hospital, Harvard Medical School, Boston, MA, USA;4. Transplantation Research Center, Renal Division, Brigham & Women''s Hospital, Harvard Medical School, Boston, Massachusetts, USA;1. Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California;2. Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California;1. Department of Medical Technology, Division of Rehabilitation Technology, Kumamoto University Hospital, Kumamoto, Japan;2. Department of Physical Medicine and Rehabilitation, Kumamoto University Hospital, Kumamoto, Japan;3. Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan;1. Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain;2. Liver Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain;3. Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain;1. Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea;2. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea |
| |
| Abstract: | BackgroundWe evaluated the efficacy and safety of eculizumab in comparison with plasmapheresis and intravenous immunoglobulin therapy in renal transplant recipients diagnosed with antibody-mediated rejection (AMR).MethodsThis was a multicenter, open-label, prospective, randomized analysis. The patients were randomized by therapy type (eg, eculizumab infusions or standard of care SOC]: plasmapheresis/intravenous immunoglobulin). The patients (ie, eculizumab arm: 7 patients, SOC arm: 4 patients) were evaluated for the continued presence of donor-specific antibodies (DSAs) and C4d (staining on biopsy), as well as histologic evidence, using repeat renal biopsy after treatment.ResultsThe allograft biopsies revealed that eculizumab did not prevent the progression to transplant glomerulopathy. Only 2 patients in the SOC arm experienced rejection reversal, and no graft losses occurred in either group. After AMR treatment, the DSA titers generally decreased compared to titers taken at the time of AMR diagnosis. There were no serious adverse effects in the eculizumab arm.ConclusionsEculizumab alone cannot treat AMR effectively and does not prevent acute AMR from progressing to chronic AMR or transplant glomerulopathy. However, it should be considered as a potential alternative therapy because it may be associated with decreased DSA levels. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
