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Rabbit anti-human thymocyte immunoglobulin for the rescue treatment of chronic antibody-mediated rejection after pediatric kidney transplantation

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A Correction to this article was published on 08 February 2018

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Abstract

Background

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.

Methods

Data were analyzed retrospectively from nine pediatric kidney transplant patients with cAMR were treated with rATG (1.5 mg/kg × 5 days) at our center after non-response to pulsed prednisolone, intravenous immunoglobulin, rituximab, and increased immunosuppressive intensity (including switching 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 glomerular filtration rate (eGFR) increased from 40 mL/min/1.73 m2 when rATG was started to 62 mL/min/1.73 m2 9 months later (p = 0.039). Four patients showed substantially higher eGFR after 9 months and 2 patients showed a small improvement; eGFR continued to decline in 3 patients after starting rATG. No grafts were lost during follow-up. At last follow-up, donor-specific antibodies (DSAs) were no longer detectable in 4 out of 8 patients for whom data were available, median fluorescence intensity had decreased substantially in 1 out of 8 patients; anti-HLA DQ DSAs persisted in 2 out of 8 patients. No adverse events with a suspected relation to rATG, including allergic reactions, leukocytopenia or infections, were observed in any of the patients.

Conclusions

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

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Change history

  • 08 February 2018

    The article “Rabbit anti-human thymocyte immunoglobulin for the rescue treatment of chronic antibody-mediated rejection after pediatric kidney transplantation”, written by Yasemen Cihan, Nele Kanzelmeyer, Jens Drube, Martin Kreuzer, Christian Lerch, Imke Hennies, Kerstin Froede, Murielle Verboom.

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Author notes

  1. Yasemen Cihan and Nele Kanzelmeyer contributed equally to the study

Authors and Affiliations

  1. Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany

    Yasemen Cihan, Nele Kanzelmeyer, Jens Drube, Martin Kreuzer, Christian Lerch, Imke Hennies, Kerstin Froede, Thurid Ahlenstiel-Grunow & Lars Pape

  2. Department of Transfusion Medicine, Hannover Medical School, Hannover, Germany

    Murielle Verboom

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  1. Yasemen Cihan
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  2. Nele Kanzelmeyer
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Correspondence to Lars Pape.

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Funding

The study received no external funding. Medical writing support by a freelance medical writer was funded by Sanofi.

Ethics

This retrospective study did not require ethical approval.

Conflicts of interest

Lars Pape has received speaker’s honoraria and travel grants from Novartis Pharmaceuticals. None of the other authors has any conflicts of interest to declare.

Additional information

A correction to this article is available online at https://doi.org/10.1007/s00467-017-3858-2.

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Cihan, Y., Kanzelmeyer, N., Drube, J. et al. Rabbit anti-human thymocyte immunoglobulin for the rescue treatment of chronic antibody-mediated rejection after pediatric kidney transplantation. Pediatr Nephrol 32, 2133–2142 (2017). https://doi.org/10.1007/s00467-017-3725-1

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