CRRT combined with immunoabsorption and plasma exchange in treatment of AMR complicated with multiple organ failure after renal transplantation

  Objective  To investigate the clinical efficacy of continuous renal replacement therapy (CRRT) combined with immunoabsorption and plasma exchange in the treatment of antibody-mediated rejection (AMR) complicated with multiple organ failure after renal transplantation.

  Methods  Twenty-eight patients diagnosed with AMR complicated with multiple organ failure after renal transplantation were randomly divided into the control group (n=12) and treatment group (n=16).All patients were given with methylprednisolone 0.8 g/d shock therapy for 5 d, oral intake of ciclosporin 1.5 mg/(kg·d), CRRT, cardiotonics, diuretics and other symptomatic treatments.In the treatment group, immunoabsorption and plasma exchange were delivered on the 7^th and 10^th d after treatment.The overall conditions were statistically compared between two groups.The changes of renal function blood urea nitrogen (BUN), serum creatinine (Scr) and blood electrolyte before and after treatment were compared between two groups.The results of histopathological examination and immunohistochemical staining of the renal tissues before and after treatment were analyzed in two groups.

  Results  Among 28 patients, 24 cases were clinically cured, including 14 in the treatment group and 10 in the control group.The symptoms of 3 patients were deteriorated, including 2 in the treatment group and 1 in the control group.One patient in the control group died of cerebral hemorrhage.After 7 d and 12 d treatment, the levels of BUN and Scr significantly differed between the treatment group and control group (P < 0.05-0.01).The levels of blood sodium and potassium significantly differed between two groups before and after treatment (P < 0.05-0.01).Pathological examination of renal tissue demonstrated that after 12 d treatment, the number of lymphocytes infiltrated in the transplanted kidney tissues was reduced and the degree of vasculitis was alleviated in two groups.Compared with the control group, the pathological scores of glomerulus, tubulointerstitial and blood vessels were significantly lower in the treatment group (all P < 0.01).Immunohistochemical staining revealed that after 12 d treatment, the number of ED1-positive monocytes in the transplanted kidney tissues was declined in both groups, especially in the treatment group.Following 12 d treatment, the ratio of CD4⁺/CD8⁺ cells in renal tubulointerstitial in the treatment group was significantly lower than that in the control group (P < 0.01).

  Conclusions   CRRT combined with immunoabsorption and plasma exchange is an effective method to treat AMR complicated with multiple organ failure following renal transplantation.