Immunoadsorption in severe C4d-positive acute kidney allograft rejection: a randomized controlled trial

Am J Transplant. 2007 Jan;7(1):117-21. doi: 10.1111/j.1600-6143.2006.01613.x. Epub 2006 Nov 15.


Antibody-mediated rejection (AMR) frequently causes refractory graft dysfunction. This randomized controlled trial was designed to evaluate whether immunoadsorption (IA) is effective in the treatment of severe C4d-positive AMR. Ten out of 756 kidney allograft recipients were included. Patients were randomly assigned to IA with protein A (N = 5) or no such treatment (N = 5) with the option of IA rescue after 3 weeks. Enrolled recipients were subjected to tacrolimus conversion and, if indicated, 'anti-cellular' treatment. All IA-treated patients responded to treatment. One death unrelated to IA occurred after successful reversal of rejection. Four control subjects remained dialysis-dependent. With the exception of one patient who developed graft necrosis, non-responders were subjected to rescue IA, however, without success. Because of a high graft loss rate in the control group the study was terminated after a first interim analysis. Even though limited by small patient numbers, this trial suggests efficiency of IA in reversing severe AMR.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Complement C4b / analysis*
  • Graft Rejection / immunology
  • Graft Rejection / prevention & control*
  • Graft Rejection / therapy
  • Humans
  • Immunotherapy / methods*
  • Kidney Transplantation / adverse effects*
  • Middle Aged
  • Necrosis
  • Peptide Fragments / analysis*
  • Renal Dialysis
  • Staphylococcal Protein A / administration & dosage
  • Staphylococcal Protein A / therapeutic use*
  • Tacrolimus / therapeutic use
  • Treatment Outcome


  • Peptide Fragments
  • Staphylococcal Protein A
  • Complement C4b
  • complement C4d
  • Tacrolimus