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Antibody depletion strategy for the treatment of suspected antibody-mediated rejection in lung transplant recipients: Does it work?

Publication ,  Journal Article
Vacha, M; Chery, G; Hulbert, A; Byrns, J; Benedetti, C; Finlen Copeland, CA; Gray, A; Onwuemene, O; Palmer, SM; Snyder, LD
Published in: Clin Transplant
March 2017

BACKGROUND: Donor-specific antibodies (DSAs) after lung transplantation correlate with poor outcomes. The ideal treatment strategy for antibody-mediated rejection AMR is not defined. Our institution implemented an aggressive multimodality protocol for the treatment of suspected AMR. METHODS: Lung transplant recipients with suspected AMR were treated with a standardized protocol of plasma exchange, steroids, bortezomib, rituximab, and intravenous immune globulin. Primary outcome was DSA clearance at 6 months in those alive. Secondary endpoints included preserved allograft function at 6 months, survival at 6 and 12 months and complications due to the protocol. RESULTS: Sixteen lung transplant recipients with documented DSA and allograft dysfunction were included in the analysis. Of the 16 patients, 11 survived to 6 months. Three of those 11 patients (27%) cleared all DSAs within 6 months of the protocol. Four of the 11 patients (36%) had preserved allograft function at 6 months. Overall 12-month patient survival was 56%. Complications included thrombocytopenia (50%) and abdominal pain or gastrointestinal discomfort (18.7%). CONCLUSIONS: This multimodality protocol resulted in clearance of DSAs and preserved lung function in a minority of lung transplant recipients with suspected AMR surviving to 6 months after therapy. There were significant side effects of the protocol.

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Published In

Clin Transplant

DOI

EISSN

1399-0012

Publication Date

March 2017

Volume

31

Issue

3

Location

Denmark

Related Subject Headings

  • Transplantation, Homologous
  • Transplant Recipients
  • Tissue Donors
  • Surgery
  • Rituximab
  • Risk Factors
  • Prognosis
  • Postoperative Complications
  • Plasmapheresis
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Vacha, M., Chery, G., Hulbert, A., Byrns, J., Benedetti, C., Finlen Copeland, C. A., … Snyder, L. D. (2017). Antibody depletion strategy for the treatment of suspected antibody-mediated rejection in lung transplant recipients: Does it work? Clin Transplant, 31(3). https://doi.org/10.1111/ctr.12886
Vacha, Mary, Godefroy Chery, Amanda Hulbert, Jennifer Byrns, Clark Benedetti, Catherine Ashley Finlen Copeland, Alice Gray, Oluwatoyosi Onwuemene, Scott M. Palmer, and Laurie D. Snyder. “Antibody depletion strategy for the treatment of suspected antibody-mediated rejection in lung transplant recipients: Does it work?Clin Transplant 31, no. 3 (March 2017). https://doi.org/10.1111/ctr.12886.
Vacha M, Chery G, Hulbert A, Byrns J, Benedetti C, Finlen Copeland CA, et al. Antibody depletion strategy for the treatment of suspected antibody-mediated rejection in lung transplant recipients: Does it work? Clin Transplant. 2017 Mar;31(3).
Vacha, Mary, et al. “Antibody depletion strategy for the treatment of suspected antibody-mediated rejection in lung transplant recipients: Does it work?Clin Transplant, vol. 31, no. 3, Mar. 2017. Pubmed, doi:10.1111/ctr.12886.
Vacha M, Chery G, Hulbert A, Byrns J, Benedetti C, Finlen Copeland CA, Gray A, Onwuemene O, Palmer SM, Snyder LD. Antibody depletion strategy for the treatment of suspected antibody-mediated rejection in lung transplant recipients: Does it work? Clin Transplant. 2017 Mar;31(3).
Journal cover image

Published In

Clin Transplant

DOI

EISSN

1399-0012

Publication Date

March 2017

Volume

31

Issue

3

Location

Denmark

Related Subject Headings

  • Transplantation, Homologous
  • Transplant Recipients
  • Tissue Donors
  • Surgery
  • Rituximab
  • Risk Factors
  • Prognosis
  • Postoperative Complications
  • Plasmapheresis
  • Male