USE OF COMBINED THERAPY BY PLASMAPHERESIS, HUMAN INTRAVENOUS IMMUNOGLOBULIN AND RITUXIMAB FOR CHRONIC RENAL ALLOGRAFT REJECTION

AIM – to evaluate efficiency of use of combined human intravenous immunoglobulin (IVIG) with plasmapheresis and rituximab for transplantation glomerulopathy in late period after kidney transplantation. PATIENTS AND METHODS. The study included 50 patients with morphologically verified transplantation glomerulopathy, 24 of which received plasmapheresis with IVIG and rituximab. Control group consisted of 26 patients without antihumoral treatment. RESULTS. At diagnosis GFR in study and control groups has no differ (44.9 Ѓ} 21.3 vs 41.2 Ѓ} 14.6 ml/min, P =0.47), but following graft function depression rate was lower in group which received treatment in comparison with control group: -0.47 Ѓ} 0.6 ml/min/month и -1.31Ѓ} 1.6 ml/min/month (p = 0.02). Therefore 3-year survivability of graft was 21.3% vs 64.8% in patients receiving treatment (Р=0,01). CONCLUSION. Our study showed that transplantation glomerulopathy as the most often variant of chronic humoral rejection is characterized by unfavorable prognosis regardless of its morphological case and process activity at diagnosis. Combined treatment including plasmapheresis, human intravenous immunoglobulin and rituximab makes it possible to delaythe progression of chronic rejection at least in some patients with chronic humoral rejection revealed in late period after renal allotransplantation.

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