Efficacy of therapeutic plasma exchange on angiotensin II type-1 receptor antibodies on two kidney transplant recipients

Chisa Yamada, Yihung Huang, Silas Norman, Abhijit Naik, Omar Moussa, Milagros Samaniego, Laura Cooling

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Angiotensin II type-1 receptor antibody (AT1RAb) has been reported to cause antibody mediated rejection (AMR) in kidney transplant recipients possibly by contraction of renal arteries. We here report 2 kidney transplant recipients with elevated AT1RAbs and negative HLA donor specific antibodies (DSA) and anti-major histocompatibility complex class I chain-related gene A (MICA) Abs who received therapeutic plasma exchange (TPE) treatment followed by IVIG. Case 1: Thirty-eight-year-old patient received second kidney transplant for end stage renal disease (ESRD) with chronic rejection. Three years post-transplant, she developed AMR with AT1RAb level >40 U/mL. She received 5 TPE and AT1RAb decreased by 20%, and biopsy showed improvement of AMR. She received another 3 TPE and AT1RAb decreased by 60%. Her creatinine (Cr) was stabilized at around 1.4 mg/dL. Case 2: Twenty-four-year-old patient received kidney transplant for ESRD with unclear etiology. Two weeks post-transplant, her Cr rose with AT1RAb level at 18 U/mL and biopsy showed possible AMR. She received 6 TPE treatments and AT1RAb decreased by 55% and biopsy showed improvement of AMR. She received weekly TPE for subsequently rising AT1RAb but TPE was discontinued because of unsuccessful decrease of AT1RAb. Her Cr was stabilized at around 1.7 mL/dL. Conclusion: We reported 2 patients who received TPE treatments to decrease AT1RAbs. A course of TPE treatment successfully decreased AT1RAb. Histological improvement was observed quickly and Cr was also stabilized following the TPE treatment. Further study is necessary to determine the optimal use of TPE in renal transplant recipients with AT1RAbs.

Original languageEnglish (US)
Pages (from-to)673-677
Number of pages5
JournalJournal of Clinical Apheresis
Volume33
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Angiotensin Type 1 Receptor
Plasma Exchange
Kidney
Antibodies
Therapeutics
Creatinine
Transplants
Transplant Recipients
Biopsy
Chronic Kidney Failure
Intravenous Immunoglobulins
Therapeutic Uses
Renal Artery
Major Histocompatibility Complex

Keywords

  • angiotensin II type-1 receptor antibody
  • antibody mediated rejection
  • kidney transplantation
  • therapeutic plasma exchange

ASJC Scopus subject areas

  • Hematology

Cite this

Efficacy of therapeutic plasma exchange on angiotensin II type-1 receptor antibodies on two kidney transplant recipients. / Yamada, Chisa; Huang, Yihung; Norman, Silas; Naik, Abhijit; Moussa, Omar; Samaniego, Milagros; Cooling, Laura.

In: Journal of Clinical Apheresis, Vol. 33, No. 6, 01.12.2018, p. 673-677.

Research output: Contribution to journalArticle

Yamada, Chisa ; Huang, Yihung ; Norman, Silas ; Naik, Abhijit ; Moussa, Omar ; Samaniego, Milagros ; Cooling, Laura. / Efficacy of therapeutic plasma exchange on angiotensin II type-1 receptor antibodies on two kidney transplant recipients. In: Journal of Clinical Apheresis. 2018 ; Vol. 33, No. 6. pp. 673-677.
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abstract = "Background: Angiotensin II type-1 receptor antibody (AT1RAb) has been reported to cause antibody mediated rejection (AMR) in kidney transplant recipients possibly by contraction of renal arteries. We here report 2 kidney transplant recipients with elevated AT1RAbs and negative HLA donor specific antibodies (DSA) and anti-major histocompatibility complex class I chain-related gene A (MICA) Abs who received therapeutic plasma exchange (TPE) treatment followed by IVIG. Case 1: Thirty-eight-year-old patient received second kidney transplant for end stage renal disease (ESRD) with chronic rejection. Three years post-transplant, she developed AMR with AT1RAb level >40 U/mL. She received 5 TPE and AT1RAb decreased by 20{\%}, and biopsy showed improvement of AMR. She received another 3 TPE and AT1RAb decreased by 60{\%}. Her creatinine (Cr) was stabilized at around 1.4 mg/dL. Case 2: Twenty-four-year-old patient received kidney transplant for ESRD with unclear etiology. Two weeks post-transplant, her Cr rose with AT1RAb level at 18 U/mL and biopsy showed possible AMR. She received 6 TPE treatments and AT1RAb decreased by 55{\%} and biopsy showed improvement of AMR. She received weekly TPE for subsequently rising AT1RAb but TPE was discontinued because of unsuccessful decrease of AT1RAb. Her Cr was stabilized at around 1.7 mL/dL. Conclusion: We reported 2 patients who received TPE treatments to decrease AT1RAbs. A course of TPE treatment successfully decreased AT1RAb. Histological improvement was observed quickly and Cr was also stabilized following the TPE treatment. Further study is necessary to determine the optimal use of TPE in renal transplant recipients with AT1RAbs.",
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AU - Samaniego, Milagros

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AB - Background: Angiotensin II type-1 receptor antibody (AT1RAb) has been reported to cause antibody mediated rejection (AMR) in kidney transplant recipients possibly by contraction of renal arteries. We here report 2 kidney transplant recipients with elevated AT1RAbs and negative HLA donor specific antibodies (DSA) and anti-major histocompatibility complex class I chain-related gene A (MICA) Abs who received therapeutic plasma exchange (TPE) treatment followed by IVIG. Case 1: Thirty-eight-year-old patient received second kidney transplant for end stage renal disease (ESRD) with chronic rejection. Three years post-transplant, she developed AMR with AT1RAb level >40 U/mL. She received 5 TPE and AT1RAb decreased by 20%, and biopsy showed improvement of AMR. She received another 3 TPE and AT1RAb decreased by 60%. Her creatinine (Cr) was stabilized at around 1.4 mg/dL. Case 2: Twenty-four-year-old patient received kidney transplant for ESRD with unclear etiology. Two weeks post-transplant, her Cr rose with AT1RAb level at 18 U/mL and biopsy showed possible AMR. She received 6 TPE treatments and AT1RAb decreased by 55% and biopsy showed improvement of AMR. She received weekly TPE for subsequently rising AT1RAb but TPE was discontinued because of unsuccessful decrease of AT1RAb. Her Cr was stabilized at around 1.7 mL/dL. Conclusion: We reported 2 patients who received TPE treatments to decrease AT1RAbs. A course of TPE treatment successfully decreased AT1RAb. Histological improvement was observed quickly and Cr was also stabilized following the TPE treatment. Further study is necessary to determine the optimal use of TPE in renal transplant recipients with AT1RAbs.

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