{"id":1623,"date":"2018-09-13T12:08:40","date_gmt":"2018-09-13T12:08:40","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=1623"},"modified":"2024-03-21T10:14:20","modified_gmt":"2024-03-21T10:14:20","slug":"treatment-of-acute-antibody-mediated-rejection","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/treatment-of-rejection\/treatment-of-acute-antibody-mediated-rejection\/","title":{"rendered":"Treatment of Acute Antibody Mediated Rejection"},"content":{"rendered":"<h3><strong><span style=\"color: #993300;\">Acute Antibody-mediated rejection (AMR)<\/span><\/strong><\/h3>\n<p>These patients are complex and treatment will be decided on a case by case basis and will not necessarily follow this guideline prescriptively (for example if evidence of cellular rejection the use of ATG may be advocated).\u00a0 A more detailed background and guidance document can be found at the foot of this page.<\/p>\n<h3><strong><span style=\"color: #993300;\">Management of AMR (in HLA &amp; ABO compatible transplants)<\/span><\/strong><\/h3>\n<p><strong><span style=\"color: #993300;\">i. Steroids<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Methylprednisolone 500mg IV given every day for 3 days<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">ii. Plasma Exchange<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>This should be started no sooner than 24 hours after a renal biopsy<\/li>\n<li>5 alternate day exchanges of 1 plasma volume, perhaps more based on severity<\/li>\n<li>Discuss with BTS regarding replacement fluid (albumin <em>vs.<\/em> FFP)<\/li>\n<li>Monitor for hypocalcaemia, bleeding and infection<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">iii. Immunoglobulin (IVIg)<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>5 doses of 100mg\/kg given at the end of each plasma exchange<\/li>\n<li>Transplant pharmacist should be notified to organise IVIg<\/li>\n<li>\n<div>The recommended rate of infusion is product-specific. Information on this can be found in Medusa (accessible from intranet) or in the product&#8217;s SPC which can be found via the EMC website:\u00a0<a id=\"OWA8823a1aa-01b3-0fba-5afc-1502309316c3\" title=\"Original URL: https:\/\/www.medicines.org.uk\/emc\/. Click or tap if you trust this link.\" href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.medicines.org.uk%2Femc%2F&amp;data=05%7C02%7CPaul.Phelan%40nhs.scot%7C106dcd72375a4e54c80608dc498ce557%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638466116692220682%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=NmPwQ0T9g2cWyDvF5XjbW7kCfgt3NCB2m%2FxYpKDHlIA%3D&amp;reserved=0\" target=\"_blank\" rel=\"noopener noreferrer\" data-auth=\"Verified\" data-linkindex=\"1\">Home &#8211; electronic medicines compendium (emc)<\/a> or speak to pharmacy<\/div>\n<\/li>\n<li>Usual observations as for patients receiving blood products apply<\/li>\n<li>Monitor temperature, pulse, BP every 15mins for first hour, then hourly thereafter<\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">iv. Additional Anti-Humoral Agents<\/span><\/strong><\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Anti B-cell or plasma cell treatments may be considered on a case by case basis<\/li>\n<li>Bortezomib 4 doses of 1.3 mg\/m<sup>2\u00a0<\/sup>S\/C (1 cycle) on days 1, 4, 8, 11. If using bortezomib, acyclovir should be used for 2 months if valganciclovir not already prescribed<\/li>\n<li>Rituximab at a dose of 375 mg\/m<sup>2<\/sup><\/li>\n<\/ul>\n<p><strong><span style=\"color: #993300;\">v. Other Immunosupression<\/span><\/strong><\/p>\n<p>This should be continued as pre standard protocol (MMF, tacrolimus)<\/p>\n<p><strong><span style=\"color: #993300;\">vi. Monitoring<\/span><\/strong><\/p>\n<p>There should be monitoring of donor specific antibody level and renal biopsy at the end of initial treatment\u00a0to assess treatment efficacy.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2024\/03\/AMR-Protocol-2017.doc\">AMR Protocol 2017<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Acute Antibody-mediated rejection (AMR) These patients are complex and treatment will be decided on a case by case basis and will not necessarily follow this guideline prescriptively (for example if evidence of cellular rejection the use of ATG may be advocated).\u00a0 A more detailed background and guidance document can be\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/treatment-of-rejection\/treatment-of-acute-antibody-mediated-rejection\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1626,"menu_order":50,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-1623","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1623","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=1623"}],"version-history":[{"count":12,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1623\/revisions"}],"predecessor-version":[{"id":6363,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1623\/revisions\/6363"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1626"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=1623"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}