Klinisch II - P26 - IVIG and high dose steroid treatment of transplant glomeru­lo­pathy effectively slows progression of loss of renal allograft function

K.A. Sablik, C.W.N. Looman, M.C. Clahsen-van Groningen, J. Damman, D.L. Roelen, M. van Agteren, M.G.H. Betjes

Chair(s): dr. Arjan van Zuilen, UMCU

Thursday 10 march 2016

13:30 - 14:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

Introduction:
Transplant glomerulopathy (TG) is commonly associated with chronic antibody mediated rejection and is a major cause of kidney allograft loss with no established effective therapy. At our centre, patients with TG within the context of chronic antibody mediated rejection are treated with intravenous immunoglobulins (IVIG) and pulse methylprednisolone (MP). In this study we analysed the efficacy of this treatment.

Patients, materials and methods:
From 2007 until 2015, 40 patients with biopsy proven TG were treated with IVIG/MP. All patients underwent a renal biopsy because of progressive decline in renal function (eGFR) at least 1 year post transplantation. Biopsies were scored according to the Banff classification. After TG was confirmed by biopsy, patients were administered three doses of 1 g intravenous MP combined with a single dose of IVIG (1 g/kg body weight). The efficacy of the treatment was analysed by comparing the slope of eGFR 12 months prior to treatment to the course of eGFR in the 12 months after treatment by linear multilevel analysis. Clinical and histomorphological parameters were analysed for association with outcome.

Results:
Treatment with IVIG/MP resulted in a significant decrease in eGFR gradient from -10.0 ml/min/1.73m2/year pre-treatment to -4.9 ml/min/1.73m2/year post-treatment (P<0.001). Three patients were non-responders returning to dialysis within the first year after treatment. No parameter associated with non-responsiveness could be identified. 29 out of 40 patients reached a 2-year follow up end-point. Data extrapolation showed that in 69% of these patients a beneficial effect is still present. Additionally, prior to IVIG/MP, proteinuria increased with an average of 0.61 g/L/year and thereafter decreased with 0.11 g/L/year (P=0.0069).

Conclusions:
IVIG/MP treatment for TG is associated with an average 50% reduction in eGFR loss within the first year after treatment and reduces proteinuria significantly. However, more efficient therapeutic options are needed.