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Clinical effect of rabbit anti-thymocyte globulin for chronic active antibody-mediated rejection after kidney transplantation

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Abstract

Chronic active antibody-mediated rejection (CAAMR) is a frequent cause of late graft loss. However, effective treatment for CAAMR after kidney transplantation has not yet been established. Here, we present the case of a kidney transplant recipient who recovered from CAAMR after administration of rabbit anti-thymocyte globulin. A 61-year-old man underwent ABO-compatible living-donor kidney transplantation for end-stage kidney disease; the kidney was donated by his wife. Five years after the transplant, the patient’s serum creatinine level and urine protein-to-creatinine ratio increased. He was subsequently diagnosed with CAAMR based on the kidney allograft biopsy and the presence of donor-specific human leukocyte antigen antibodies. Rabbit anti-thymocyte globulin treatment was administered following steroid pulse therapy. Subsequently, his serum creatinine levels and urine protein to creatinine ratio improved. There was also an improvement in the pathological findings seen on biopsy and the mean fluorescence intensity of donor-specific antibodies. In conclusion, this report describes the case of a kidney transplant recipient who developed CAAMR, treated using rabbit anti-thymocyte globulin. This strategy might be a viable treatment option for CAAMR after a kidney transplant.

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Abbreviations

CAAMR:

Chronic active antibody-mediated rejection

CMV:

Cytomegalovirus

DSA:

Donor-specific antibodies

eGFR:

Estimated glomerular filtration rate

HLA:

Human leukocyte antigen

IVIg:

Intravenous immunoglobulin

MFI:

Mean fluorescence intensity

MMF:

Mycophenolate mofetil

mPSL:

Methylprednisolone

PRA:

Panel reactive antibody

rATG:

Rabbit anti-thymocyte globulin

TAC-ER:

Extended-release tacrolimus

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Acknowledgements

We are grateful to Dr. Kyo M. for the discussions of pathological findings.

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Authors and Affiliations

  1. Department of Urology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Shumiyoshiku, Osaka City, Osaka, 558-8558, Japan

    Ryo Tanaka, Koichi Tsutahara, Shunsuke Inoguchi, Hiromu Horitani, Toshihisa Asakura, Norihiko Kawamura, Yoichi Kakuta, Masahiro Nakagawa & Tetsuya Takao

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  1. Ryo Tanaka
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  2. Koichi Tsutahara
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  3. Shunsuke Inoguchi
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  4. Hiromu Horitani
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  5. Toshihisa Asakura
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  6. Norihiko Kawamura
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  7. Yoichi Kakuta
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  8. Masahiro Nakagawa
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  9. Tetsuya Takao
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Correspondence to Koichi Tsutahara.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at which the studies were conducted and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Tanaka, R., Tsutahara, K., Inoguchi, S. et al. Clinical effect of rabbit anti-thymocyte globulin for chronic active antibody-mediated rejection after kidney transplantation. CEN Case Rep 11, 79–83 (2022). https://doi.org/10.1007/s13730-021-00633-7

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  • DOI: https://doi.org/10.1007/s13730-021-00633-7

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