Tratamiento del rechazo agudo hiperinmune con plasmaféresis y Rituximab. Nuestra Experiencia

Abstract

Kidney transplantation involves the removal of a kidney from a healthy individual and its placement in a patient with end-stage chronic renal failure¹. Immunological rejection is the main complication after transplantation. Rejection is the set of clinical, functional, anatomopathological manifestations that can appear in a kidney transplant recipient, as a consequence of the activation of the immune system against the graft. Rejection can appear from the moment of revascularisation of the organ until years later². The incidence of rejection will depend essentially on two factors: the characteristics of the recipient and the immunosuppressive treatment used. It is generally accepted that 30-40% of patients develop some episode of rejection in the immediate transplant (first 3 months)¹. In most protocols, methyl-prednisolone boluses are used as conventional treatment at doses ranging from 250 to 1,000mg/day, for 3-4 days. With this guideline, a response is achieved in 60-70% of cases. In the rest of the cases there is corticorresistant rejection². Plasmapheresis has been recently introduced in the treatment of acute rejection of renal transplantation resistant to conventional steroid treatment³. Apheresis can be defined as a therapeutic modality that consists of the extraction of a determined volume of plasma (2 to 5 litres) with the aim of eliminating those pathogens considered responsible for a disease or its clinical manifestations. Plasma exchange by filtration through membranes is carried out by means of an extracorporeal circuit.