BACKGROUND Chronic active antibody-mediated rejection is a major etiology of graft loss in renal transplant recipients. However, there is no consensus on the optimal treatment strategies. METHODS Computerized records from Taichung Veterans General Hospital were collected to identify renal transplant biopsies performed in the past 7 years with a diagnosis of chronic active antibody-mediated rejection. The patients were divided into two groups according to treatment strategy: Group 1 received aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2 received supportive treatment. RESULTS From February 2009 to December 2017, a total of 82 patients with biopsy-proven chronic antibody mediated rejection were identified. Kaplan-Meier analysis of death-censored graft survival showed a worse survival in group 2 (P = 0.015 by log-rank test). Adverse event-free survival was lower in group 1, whereas patient survival was not significantly different. Proteinuria and supportive treatment were independent risk factors for graft loss in multivariate analysis. CONCLUSIONS Aggressive treatment was associated with better graft outcome. However, higher incidence of adverse events merit personalized treatment, especially for those with higher risk of infection. Appropriate prophylactic antibiotics are recommended for patients undergoing aggressive treatment.

中文翻译：

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肾移植受者中慢性活性抗体介导的排斥反应的治疗-单中心回顾性研究。

背景技术慢性活性抗体介导的排斥反应是肾移植接受者中移植物丢失的主要病因。但是，关于最佳治疗策略尚无共识。方法收集台中荣民总医院的计算机记录，以鉴定过去7年进行的肾移植活检，诊断为慢性活性抗体介导的排斥反应。根据治疗策略将患者分为两组：第1组接受积极治疗（双重滤过血浆置换术和下列治疗方案之一：利妥昔单抗，静脉内免疫球蛋白，抗胸腺球蛋白球蛋白，硼替佐米或甲基强的松龙脉冲疗法）；第2组接受了支持治疗。结果从2009年2月到2017年12月，总共鉴定了82例经活检证实的慢性抗体介导的排斥反应的患者。Kaplan-Meier分析以死亡检查的移植物存活率显示第2组存活率较差（对数秩检验，P = 0.015）。第1组不良无事件生存率较低，而患者生存率无显着差异。在多变量分析中，蛋白尿和支持治疗是造成移植物丢失的独立危险因素。结论积极的治疗与较好的移植物预后相关。但是，不良事件的发生率较高，值得个性化治疗，尤其是对于那些感染风险较高的患者。建议对积极治疗的患者使用适当的预防性抗生素。015（通过对数秩检验）。第1组不良无事件生存率较低，而患者生存率无显着差异。在多因素分析中，蛋白尿和支持治疗是造成移植物丢失的独立危险因素。结论积极的治疗与较好的移植物预后相关。但是，不良事件的发生率较高，值得个性化治疗，尤其是对于那些感染风险较高的患者。建议对积极治疗的患者使用适当的预防性抗生素。015（通过对数秩检验）。第1组不良无事件生存率较低，而患者生存率无显着差异。在多变量分析中，蛋白尿和支持治疗是造成移植物丢失的独立危险因素。结论积极的治疗与较好的移植物预后相关。但是，不良事件的发生率较高，值得个性化治疗，尤其是对于那些感染风险较高的患者。建议对积极治疗的患者使用适当的预防性抗生素。不良事件的发生率较高，值得个性化治疗，尤其是对于那些感染风险较高的患者。建议对积极治疗的患者使用适当的预防性抗生素。不良事件的发生率较高，值得个性化治疗，尤其是对于那些感染风险较高的患者。建议对积极治疗的患者使用适当的预防性抗生素。