Acute humoral renal allograft rejection (AHR) is a condition that severely affects the graft survival which is associated with specific pathologic changes in the graft. The best treatment of this condition remains undefined. Preliminary data suggests that patients with acute humoral rejection may also respond to treatment with plasmapheresis, tacrolimus, and mycophenolate mofetil, plasmapheresis plus intravenous immune globulin, or immunoadsorption. We studied the outcome of renal allograft of 12 patients with AHR who underwent plasma exchange (PE) therapy. We retrospectively analyzed all kidney transplants performed at our center between November 1995 and May 2002. We selected the patients if they underwent PE and had two of the following criteria: 1) characteristic histological features of antibody-mediated rejection, 2) posttransplant positive cross-match or panel, 3) historic positive panel, 4) failure to respond to treatment with steroids and/or antilymphocytic agents. Recipients were classified into two groups according to their response to the treatment: responders (8 patients) and non –responders.
In the demographic data there was a trend toward the predominance of woman (66%) in all of our patients and also in non-responders group (75%).We also noted that the interval between creatinine rise and the initiation of PE was longer in non-responders group (17 days vs. 9). Five-year graft survival in the responders was 85%. The overall mean creatinine for responders group is 1.47± 0.57(mg/dl). Our findings suggest that PE treatment has the potential to improve the outcome of AHR.