Plasma exchange, rituximab might prevent aHUS recurrence after kidney transplant

Researchers called treatment potentially 'lifesaving' for transplant patients

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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Plasma exchange combined with rituximab, an immunosuppressant, might prevent atypical hemolytic uremic syndrome (aHUS) from coming back after a kidney transplant, according to a small study from India.

The study, “Kidney Transplant Outcomes in Patients with Atypical Hemolytic Uremic Syndrome,” was published in Transplantation Proceedings.

aHUS is a disease where blood clots form in the small blood vessels of the kidneys and sometimes other organs. This can damage the kidneys and keep them from working as they should.

About half of aHUS patients develop end-stage kidney disease, which occurs when the kidneys no longer function at a level needed for daily life. When this happens, patients may need dialysis, which takes over the function of filtering blood, or a kidney transplant.

Kidney transplants can mean a higher risk of aHUS coming back and affect the new kidney. While Soliris (eculizumab) can help maintain kidney function, it may not be widely available. Researchers in India explored whether more “conventional measures” could help maintain kidney function and assessed the effectiveness of plasma exchange to treat or prevent aHUS from recurring in patients who’d had a kidney transplant.

Also called plasmapheresis, plasma exchange removes disease-causing antibodies from the bloodstream. It can be used with an immunosuppressant such as rituximab, which reduces the number of antibody-producing immune cells.

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Higher doses of Soliris needed for AHUS patient in rare case: Study

Reducing aHUS disease recurrence

The researchers looked at the medical records of five men who’d had a kidney transplant. The men had a mean age of 24.2 and all had a level of anti-complement factor H (CFH) antibodies, a known cause of aHUS, greater than 100 arbitrary units per milliliter (AU/mL).

One man received an aHUS diagnosis within two weeks after his transplant. At this point, his anti-CFH antibody level was 276 AU/mL. He had five sessions of plasma exchange with two doses of 500 mg rituximab given a week apart.

Over a follow-up of 478 days (about 1.3 years) after the transplant, his anti-CFH antibody level went above 600 AU/mL, but his kidney function remained relatively stable.

The other four men received their aHUS diagnosis before their transplant. They had five sessions of plasma exchange on average. One man had two 500 mg rituximab doses and two men received a single dose. The other man didn’t receive rituximab.

The mean anti-CFH antibody level dropped from 466.8 AU/mL to 90.3 AU/mL after plasma exchange and rituximab treatment. At a mean follow-up of 223 days, kidney function remained intact.

“Plasma exchange and rituximab can be beneficial in terms of preventing graft dysfunction and reducing disease recurrence in the post-transplant period,” the researchers wrote. “Our approach can be lifesaving for patients with aHUS undergoing kidney transplantation in a resource-limited setting.”