Advanced Search
Clear
4 results
Filters
Sort By
Results Per Page
Filters
Advanced Search
Clear
4 results
Download the following citations:
Email the following citations:
Print the following citations:
  • Heo S
  • Park Y
  • Lee N
  • Kim Y
  • Kim YN
  • et al.
Transplant Proc. 2022 Oct;54(8):2117-2124 doi: 10.1016/j.transproceed.2022.08.008.
CET Conclusion
Reviewer: Mr John O'Callaghan, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This is a small randomised controlled trial in Antibody Mediated Rejection (AMR) of renal transplants. Patients with confirmed AMR were randomised to standard care (plasmapheresis and IVI Ig as prescribed by clinicians) or to eculizimab infusion. There were 11 patients included, so a relatively small number, but this would have been dependent on a low number of potential patients to include. The study commenced in 2013 and has only just come to publication. It is not clear that the study was adequately randomised, and there was also the possibility for patients to cross over to the other arm if treatment failed, which further confuses the results and interpretation. There was also considerable variation in additional treatments, such as the use of Campath, Basiliximab, Rituximab and ATG. The main conclusion to draw from this small study is that eculizumab alone did not reverse rejection in any case, prevent progression to chronic AMR or transplant glomerulopathy.
Aims: This study aimed to compare the efficacy and safety of eculizumab versus plasmapheresis (PP) and intravenous immunoglobulin therapy (IVIG) in kidney transplant patients with antibody-mediated rejection (AMR).
Interventions: Participants were randomly assigned to receive either eculizumab or standard of care (PP combined with IVIG).
Participants: 11 kidney transplant recipients between 18 and 75 years of age.
Outcomes: The main outcomes of interest were as follows: mean serum creatinine, rejection reversal, graft loss and serious adverse events.
Follow Up: 12 months
BACKGROUND:

We evaluated the efficacy and safety of eculizumab in comparison with plasmapheresis and intravenous immunoglobulin therapy in renal transplant recipients diagnosed with antibody-mediated rejection (AMR).

METHODS:

This was a multicenter, open-label, prospective, randomized analysis. The patients were randomized by therapy type (eg, eculizumab infusions or standard of care [SOC]: plasmapheresis/intravenous immunoglobulin). The patients (ie, eculizumab arm: 7 patients, SOC arm: 4 patients) were evaluated for the continued presence of donor-specific antibodies (DSAs) and C4d (staining on biopsy), as well as histologic evidence, using repeat renal biopsy after treatment.

RESULTS:

The allograft biopsies revealed that eculizumab did not prevent the progression to transplant glomerulopathy. Only 2 patients in the SOC arm experienced rejection reversal, and no graft losses occurred in either group. After AMR treatment, the DSA titers generally decreased compared to titers taken at the time of AMR diagnosis. There were no serious adverse effects in the eculizumab arm.

CONCLUSIONS:

Eculizumab alone cannot treat AMR effectively and does not prevent acute AMR from progressing to chronic AMR or transplant glomerulopathy. However, it should be considered as a potential alternative therapy because it may be associated with decreased DSA levels.

  • Kim JM
  • Kim K
  • Lee N
  • Cho C
  • Kim HJ
  • et al.
26th International Congress of The Transplantation Society, August 18-23, 2016, Hong Kong.. 2016.
26th International Congress of The Transplantation Society, August 18-23, 2016, Hong Kong.
  • Kobashigawa JA
  • Leaf DA
  • Lee N
  • Gleeson MP
  • Liu H
  • et al.
N Engl J Med. 1999 Jan 28;340(4):272-7 doi: 10.1056/NEJM199901283400404.
BACKGROUND:

In patients who have received a cardiac transplant, the denervated donor heart responds abnormally to exercise and exercise tolerance is reduced. The role of physical exercise in the treatment of patients who have undergone cardiac transplantation has not been determined. We assessed the effects of training on the capacity for exercise early after cardiac transplantation.

METHODS:

Twenty-seven patients who were discharged within two weeks after receiving a heart transplant were randomly assigned to participate in a six-month structured cardiac-rehabilitation program (exercise group, 14 patients) or to undergo unstructured therapy at home (control group, 13 patients). Each patient in the exercise group underwent an individualized program of muscular-strength and aerobic training under the guidance of a physical therapist, whereas control patients received no formal exercise training. Cardiopulmonary stress testing was performed at base line (within one month after heart transplantation) and six months later.

RESULTS:

As compared with the control group, the exercise group had significantly greater increases in peak oxygen consumption (mean increase, 4.4 ml per kilogram of body weight per minute [49 percent] vs. 1.9 ml per kilogram per minute [18 percent]; P=0.01) and workload (mean increase, 35 W [59 percent] vs. 12 W [18 percent]; P=0.01) and a greater reduction in the ventilatory equivalent for carbon dioxide (mean decrease, 13 [20 percent] vs. 6 [11 percent]; P=0.02). The mean dose of prednisone, the number of patients taking antihypertensive medications, the average number of episodes of rejection and of infection during the study period, and weight gain did not differ significantly between the groups.

CONCLUSIONS:

When initiated early after cardiac transplantation, exercise training increases the capacity for physical work.

  • Kobashigawa J
  • Leaf D
  • Gleeson M
  • Hamilton MA
  • Chelimsky-Fallick C
  • et al.
J Heart Lung Transplant. 1994;13(1 part 2):S77.
14th annual meeting of the International Society for Heart and Lung Transplantation