ESPN 50th Annual Meeting

ESPN 2017


 
Rabbit anti-human thymocyte immunoglobulin for rescue treatment of chronic antibody-mediated rejection after pediatric kidney transplantation
YASEMEN CIHAN 1 THURID AHLENSTIEL-GRUNOW 1 JENS DRUBE 1 MARTIN KREUZER 1 CHRISTIAN LERCH 1 NELE KANZELMEYER 1 IMKE HENNIES 1 KERSTIN FROEDE 1 MURIELLE VERBOOM 2 LARS PAPE 1

1- DEPARTMENT OF PEDIARIC NEPHROLOGY, HANNOVER MEDICAL SCHOOL
2- DEPARTMENT OF TRANSFUSION MEDICINE, HANNOVER MEDICAL SCHOOL
 
Introduction:

Chronic antibody-mediated rejection (cAMR) is the leading cause of late kidney graft loss but current therapies are often ineffective. Rabbit anti-human thymocyte immunoglobulin (rATG) may be helpful but its use is virtually undocumented.

Material and methods:

Nine pediatric kidney transplant patients with cAMR were treated with rATG (1.5mg/kg x 5 days) at our center after non-response to pulsed prednisolone, intravenous immunoglobulin, rituximab and increased immunosuppressive intensity (including switch to belatacept in some cases), with or without bortezomib.

Results:

The median time from diagnosis to cAMR was 179 days. rATG was started 5–741 days after diagnosis. Median estimated GFR increased from 40mL/min/1.73m2 when rATG was started to 62mL/min/1.73m2 nine months later (p=0.039). Four patients showed substantially higher eGFR after nine months and two patients showed a small improvement; eGFR continued to decline in three patients after starting rATG. No grafts were lost during follow-up. At last follow-up DSA were no longer detectable, or median fluorescence intensity had decreased, in 7/8 patients for whom data were available. No adverse events with a suspected relation to rATG, including allergic reactions, leukocytopenia or infections, were observed in any patient.

Conclusions:

In conclusion, in this small series of patients rATG appears a promising treatment for unresponsive cAMR. Further evaluation, including earlier introduction of rATG, is warranted.