A CLINICAL AUDIT OF KIDNEY TRANSPLANT RECIPIENTS WITH ANTIBODY MEDIATED REJECTION IN SOUTHERN TASMANIA.

B PATEL1, A NEJATIAN1, L SKEAT2,  G KIRKLAND2,  M JOSE1,2

1School of Medicine, University of Tasmania, Launceston, Australia, 2Renal Unit, Royal Hobart Hospital, Launceston, Australia

Aim: To review the diagnosis, management and outcomes of antibody-mediated rejection (AMR) in kidney transplant patients treated with intravenous immunoglobulin (IVIG) in southern Tasmania.
Background: Accurately diagnosing and treating AMR is crucial to preventing transplant failure and improving long term patient outcomes.
Methods: This retrospective clinical audit reviewed renal transplant patients with AMR managed by the Royal Hobart Hospital and treated with IVIG between 1/1/2009 and 31/12/2019 using AUDIT4 and Digital Medical Records. AMR was diagnosed as per Banff criteria.
Results: We identified 25 patients (13 (52%) females), mean age 58 years (range 32-74 years) diagnosed with AMR and treated with IVIG during the study period. HLA mismatches with donor kidney were a mean of 3 MHC class 1 and 1 MHC class 2 mismatches. Patients received between 2 and 22 IVIG treatments at an average dose of 0.53g/Kg each, with up to 20 sessions of plasma exchange (PEX). At 12-months post biopsy, half (46%) of the patients had reduced eGFR (defined as >10% decrease compared to base values at biopsy) after receiving an average of 10.2 IVIG treatments at 0.55g/Kg each and 6.5 PEX at 19L total volume. The other half (54%) of patients had either stable (within 10% of base values) or improved eGFR (defined as >10% increase compared to base values at biopsy) after receiving an average of 5.8 IVIG treatments at 0.51g/Kg each and 6.6 PEX at 21.8L total volume. Four (16%) patients experienced IVIG side effects including migraines and nausea.
Conclusion: Following treatment with IVIG slightly more than half of the patients with AMR showed stabilisation or improvement in renal function.


Biography:
Bansari Patel is currently undertaking her fourth year of study in the Bachelor of Medicine and Bachelor of Surgery at the University of Tasmania (UTAS). She has previously completed a Bachelor of Medical Research at UTAS and is passionate about clinical research and staying up to date with evidence based medicine in the management of patients with chronic health conditions.

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