Nancy Perrottet, Mario Fernández-Ruiz, Isabelle Binet, Michael Dickenmann, Suzan Dahdal,Karine Hadaya, Thomas Müller, Stefan Schaub, Michael Koller, Samuel Rotman, Solange Moll, Helmut Hopfer, Jean-Pierre Venetz, Vincent Aubert, Léo Bühler, Jurg Steiger, Oriol Manuel, Manuel Pascual, Dela Golshayan , and the Swiss Transplant Cohort Study (STCS)
Abstract
Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR.
Introduction
Acute antibody-mediated rejection (AMR) is a potential cause of kidney allograft loss [1–3]. Despite significant advances on the recognition and diagnostic strategies of this clinical entity, the efficacy and safety of the different therapeutic approaches of AMR are not fully established [4]. In 2009, the Kidney Disease Improving Global Outcomes (KDIGO) clinical guidelines recommended a number of treatment alternatives, with or without corticosteroids (grade 2C recommendations), including plasmapheresis, intravenous immunoglobulins (IVIg), anti-CD20 monoclonal antibody (mAb), and lymphocyte-depleting antibodies [5]. These recommendations were recently updated by The Transplantation Society Working Group, and the standard of care for acute active AMR remains plasmapheresis, IVIg (grade 2C) with corticosteroids (expert opinion), and adjunctive therapy in specific settings (grade 2B) [6].
Discussion
In this large nationwide cohort of KT recipients, 3.9% of patients experienced an acute AMR episode that was managed using a large variety of therapeutic approaches within the first year post-transplantation. As the pathogenesis and diagnostic criteria of acute AMR have been refined over the past fifteen years, we did not expect such heterogeneity in the therapeutic practices in this prospective contemporary cohort. Our observation however reflects the lack of validated recommendations regarding the treatment of AMR after kidney transplantation.
Citation: Perrottet N, Fernández-Ruiz M, Binet I, Dickenmann M, Dahdal S, Hadaya K, et al. (2021) Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study. PLoS ONE 16(4): e0250829. https://doi.org/10.1371/journal.pone.0250829
Editor: Justyna Gołębiewska, Medical University of Gdansk, POLAND
Received: December 30, 2020; Accepted: April 15, 2021; Published: April 30, 2021
Copyright: © 2021 Perrottet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information file.
Funding: This study was conducted in the framework of the STCS, supported by the Swiss National Science Foundation, the Swiss University Hospitals and Transplant Centers. M.F.R. has been supported by an educational grant from the Spanish Society of Transplantation. He currently holds a research contract “Miguel Servet” (CP18/00073) from the Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation. D.G. has been supported by the Fondation Pierre Mercier pour la Science and a research grant by Novartis Foundation The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.