Refractory Acute Renal Allograft Rejection Successfully Treated With Photopheresis

• Published in: Transplantation proceedings Vol. 37; no. 8; pp. 3288 - 3289
• Main Authors: Genberg, H., Kumlien, G., Shanwell, A., Tydén, G.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2005; Elsevier Science
• Subjects: Acute Disease; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; Creatinine - blood; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - therapy; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - immunology; Medical sciences; Medicin och hälsovetenskap; Muromonab-CD3 - therapeutic use; Photopheresis; Prognosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; T-Lymphocytes - immunology; Tissue, organ and graft immunology; Transplantation, Homologous; Treatment Outcome; Graft(material); Treatment resistance; Acute; Transplantation; Homotransplantation; Kidney; Phototherapy; Medicine; Rejection; Refractory; Treatment; Urinary system; Surgery; Graft; Photopheresis
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.09.003

Acute rejection episodes still occur in spite of modern immunosuppressive protocols. We present seven patients with biopsy-proven acute rejections after kidney transplantation refractory to repeated pulses of high-dose steroids and antithymocyte globulin (ATG) or OKT-3, but responsive to photopheresis therapy. Photopheresis is a nontoxic immunomodulatory, apheresis-based treatment with no general immunosuppressive action. Rather, it suppresses specific pathogenic T-cell clones. During photopheresis mononuclear leukocytes are collected from the patient using centrifugation technique, treated with a photosensitizing agent, irradiated, and subsequently retransfused. All patients tolerated the treatment well, with no notable side effects. At the 12-month follow-up the median creatinine had decreased to 161 μmol/L compared to 282 μmol/L at the start of photopheresis and at the last follow-up 12 to 43 months after transplantation all patients still had functioning grafts. In five of the seven cases there had been a significant improvement in renal function, whereas in two of the patients the renal function remained stable but without a decrease in creatinine. It is our experience that the prognosis for renal allografts with acute rejection unresponsive to conventional antirejection treatment (ie, repeated pulses of methylprednisolone and ATG or OKT-3) is very poor. Therefore, we conclude that the photopheresis treatment contributed to the favorable outcome in this small group of patients. We are presently designing a prospective randomized study to further evaluate the effect of photopheresis after renal transplantation.