Resumen
Introducción: el rechazo de injerto renal mediado por anticuerpos constituye una de las causas principales de pérdida de los injertos. El tratamiento se basa en la remoción de los anticuerpos circulantes, la inhibición de los anticuerpos residuales, la disminución de la formación de estos, la minimización de la alorrespuesta y la activación terminal del complemento.
Objetivo: valorar la respuesta terapéutica en pacientes a quienes se les administró inmunoglobulina intravenosa, plasmaféresis, esteroide y rituximab como tratamiento para rechazo de injerto renal mediado por anticuerpos.
Material y métodos: estudio aplicativo y prospectivo, realizado en pacientes hospitalizados en un servicio de nefrología con diagnóstico de rechazo del injerto renal mediado por anticuerpos de acuerdo con la clasificación BANFF. Se integraron 20 pacientes en un año, se revisó la biopsia para clasificar el tipo de rechazo mediado por anticuerpos y se evaluó la respuesta al tratamiento para demostrar si había estabilización o mejoría de la función renal a 12 meses de seguimiento.
Resultados: mediante prueba de Wilcoxon se comparó la creatinina durante la biopsia del injerto y la creatinina a 12 meses de que los pacientes recibieron el esquema terapéutico. El valor de Z fue de −1.8 y el de la p = 0.069.
Conclusiones: no hubo diferencia en cuanto a estabilización o recuperación de la función del injerto renal después de 12 meses de recibir tratamiento para rechazo mediado por anticuerpos a base de esteroide, recambios plasmáticos, inmunoglobulina y rituximab.
Abstract
Background: Antibody-mediated renal graft rejection is one of the main causes of graft loss. Treatment is based on the removal of circulating antibodies, inhibition of residual antibodies, reduction of their formation, minimization of the alloresponse and terminal complement activation.
Objective: To assess the therapeutic response in patients who received intravenous immunoglobulin, plasmapheresis, steroid and rituximab as treatment for antibody-mediated renal rejection.
Material and methods: An applicative, prospective study was carried out in hospitalized patients under the care of a nephrology service with a diagnosis of antibody-mediated rejection of the renal graft according to BANFF. 20 patients were included in 1 year, the biopsy was reviewed in an effort to classify the type of antibody-mediated rejection and the response to treatment was evaluated to demonstrate whether there was stabilization or improvement in renal function at 12 months of follow-up.
Results: Using the Wilcoxon test, creatinine during the biopsy of the injected and creatinine 12 months after receiving the therapeutic regimen were compared. The Z value was −1.8, with a p = 0.069.
Conclusions: There was no difference in terms of stabilization or recovery of renal graft function after 12 months of receiving treatment for antibody-mediated rejection based on steroids, plasma exchanges, immunoglobulin and rituximab.
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