Pediatr Transplant. 2025 Sep;29(6):e70132. doi: 10.1111/petr.70132.
ABSTRACT
BACKGROUND: Intravenous corticosteroids and anti-thymocyte globulin (ATG) are standard treatment agents for acute T-cell mediated rejection (TCMR). Little data exist on the role of second-line treatment agents for TCMR when refractory to standard agents. Local graft irradiation (LGI) was historically used but there are few reports of its use in the modern era.
METHODS: Five patients underwent a LGI protocol (150 cGy × 3 doses) for biopsy-proven TCMR that was persistent after treatment with maximally tolerated standard agents. Outcomes included post-LGI biopsy findings, serum creatinine (SCr) at 1 week, 1 month, and 12 months after LGI & graft survival and subsequent rejection episodes at last evaluation.
RESULTS: In three of five cases, active TCMR resolved on post-LGI biopsy. One patient did not undergo post-LGI biopsy, and one patient had persistent TCMR requiring further salvage therapy. Four patients had ongoing graft survival with no further episodes of acute TCMR at last evaluation (6-119 months). One patient had graft loss requiring return to dialysis at 5 months post-LGI. One patient had acute endothelial injury on post-LGI biopsy associated with a rise in SCr at 1 week and 1 month post-LGI. All other patients had no change or improvement in serum creatinine at these time points.
CONCLUSION: LGI may be a viable salvage therapy in pediatric and young adult patients experiencing TCMR refractory to traditional treatments. We suggest further studies to fully assess the efficacy and risk of this therapy in clinical practice.
PMID:40785033 | DOI:10.1111/petr.70132
