B PATEL1, A NEJATIAN1, L SKEAT2, G KIRKLAND2, M JOSE1,2
1School of Medicine, University of Tasmania, Launceston, Australia, 2Renal Unit, Royal Hobart Hospital, Launceston, Australia
Aim: To review the diagnosis, management and outcomes of antibody-mediated rejection (AMR) in kidney transplant patients treated with intravenous immunoglobulin (IVIG) in southern Tasmania.
Background: Accurately diagnosing and treating AMR is crucial to preventing transplant failure and improving long term patient outcomes.
Methods: This retrospective clinical audit reviewed renal transplant patients with AMR managed by the Royal Hobart Hospital and treated with IVIG between 1/1/2009 and 31/12/2019 using AUDIT4 and Digital Medical Records. AMR was diagnosed as per Banff criteria.
Results: We identified 25 patients (13 (52%) females), mean age 58 years (range 32-74 years) diagnosed with AMR and treated with IVIG during the study period. HLA mismatches with donor kidney were a mean of 3 MHC class 1 and 1 MHC class 2 mismatches. Patients received between 2 and 22 IVIG treatments at an average dose of 0.53g/Kg each, with up to 20 sessions of plasma exchange (PEX). At 12-months post biopsy, half (46%) of the patients had reduced eGFR (defined as >10% decrease compared to base values at biopsy) after receiving an average of 10.2 IVIG treatments at 0.55g/Kg each and 6.5 PEX at 19L total volume. The other half (54%) of patients had either stable (within 10% of base values) or improved eGFR (defined as >10% increase compared to base values at biopsy) after receiving an average of 5.8 IVIG treatments at 0.51g/Kg each and 6.6 PEX at 21.8L total volume. Four (16%) patients experienced IVIG side effects including migraines and nausea.
Conclusion: Following treatment with IVIG slightly more than half of the patients with AMR showed stabilisation or improvement in renal function.
Bansari Patel is currently undertaking her fourth year of study in the Bachelor of Medicine and Bachelor of Surgery at the University of Tasmania (UTAS). She has previously completed a Bachelor of Medical Research at UTAS and is passionate about clinical research and staying up to date with evidence based medicine in the management of patients with chronic health conditions.