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In “Antibody-Mediated Rejection,” Dr. Arjang Djamali provides a concise overview of this difficult topic
for the Transplant in 10 audience. This video can be watched in conjunction with the
“Approaches Towards Desensitization”
Tx10 presentation given by Dr. Stanley Jordan.
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Patricia Bianco
8/28/19 6:03 pm
Thank you very much for your lecture!! I would like to ask how much we are “allowed” to push treatment? Some patients are aging, the degree of chronic damage? Risk of infection? Cancer? As consequence of the treatment we choose. The balance is quite challenging.
Do you think only increasing the dose of tacrolimus and mycophenolate would it be enough?
Please give is your thoughts about it.
Best regards
Patrícia
Brian Valeria
8/30/19 10:49 am
Posted on behalf of Dr. Djamali, in response to Dr. Bianco's question: "Dear Dr. Bianco: Thank you for your comment and very important question. As you outline very appropriately, our challenging job as transplant nephrologists is to balance the risks of over and under-immunosuppression. Unfortunately, there is limited evidence for risk stratification in patients with chronic ABMR, and there is no FDA-approved standard therapy. We have reviewed this topic in UpToDate (expert opinion ????) but briefly, in “high risk” patients with chronic ABMR, a conservative approach as you indicate is reasonable. Observational studies from our group suggest that patients with poor kidney function (Scr >3), proteinuria (>1 g), high chronicity score (>8/12), and high DSA (MFI > 2500) have the worst outcome (PMID: 26867813, PMID: 29536028) so you may consider a more cautious treatment strategy in this subgroup. Hope this helps!"
Patricia Bianco
8/28/19 6:03 pm
Thank you very much for your lecture!! I would like to ask how much we are “allowed” to push treatment? Some patients are aging, the degree of chronic damage? Risk of infection? Cancer? As consequence of the treatment we choose. The balance is quite challenging. Do you think only increasing the dose of tacrolimus and mycophenolate would it be enough? Please give is your thoughts about it. Best regards Patrícia