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Abstract: PO2575

Effect of Therapeutic Plasma Exchange on Glomerular Filtration Rate in Patients with Antibody-Mediated Rejection

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Maza Moreno, Miguel, National Medical Center 20 de Noviembre, Mexico City, Mexico
  • Hernández-Estrada, Sergio, National Medical Center 20 de Noviembre, Mexico City, Mexico
  • Cano, Jose Horacio, National Medical Center 20 de Noviembre, Mexico City, Mexico
  • Diaz Avendaño, Odette Del Carmen, National Medical Center 20 de Noviembre, Mexico City, Mexico
  • Maldonado Tapia, Diana, National Medical Center 20 de Noviembre, Mexico City, Mexico

Group or Team Name

  • Nephrology and Transplant Division
Background

AMR is the main risk factor for graft loss, especially after the first post-transplant year. Up to 80% of patients achieve response with immunosuppressive treatment and TPE, although the response is lower in patients with lateAMR. The objective was to determine the effect of TPEonGFR at 0,1, and 3 months postTPE.

Methods

Retrospective study that included patients with a renal transplant of the CMN“November 20”in MexicoCity, from 2016to2019, undergoing membrane TPEforAMR. Analysis was performed using student's t or MannWhitneyU, repeated measures analysis, and Spearman or Pearson test. Significant p was less than 0.05.

Results

25 patients with AMR who received TPE were evaluated. Age:32±11.6 years, 72% from living donor, 52% received Basiliximab. 87% received tacrolimus. 80% of AMR were late. Prevalence of HLAclass II DSA(66%), specifically vs DQandDR (57.2% and 28.8%). There was a significant difference between preTPE GFR and at the end of treatment(p=0.015, r=0.53), and no significant differences between preTPE GFR, with 1or3 monthGFR(p=0.58; p=0.36). When evaluating IFTA or histological score(g+ptc), no difference was detected in the GFR at 1or3 months post-TPE. When comparing the effect of the AMR temporality on the GFR, difference was found at 1and3 months (p=0.022; p=0.01) postTPE, with lower recovery of GFR in patients with early AMR. There was a moderate correlation between GFR at the time of diagnosis of rejection and GFR at 3 months postTPE(r2=0.68,p=0.01), Fig. 1.

Conclusion

Significant difference was demonstrated between the preTPE GFR and immediate postTPE GFR. In our study patients with early AMR presented a poor response to treatment. The GFRupon admission correlated positively with theGFR detected at 3months post-TPE. This suggests a beneficial effect of TPE over GFRfall during the first 3months after diagnosis.