Case report: Eculizumab rescue of severe accelerated antibody-mediated rejection after ABO-incompatible kidney transplant

Z A Stewart; T E Collins; A J Schlueter; T I Raife; D G Holanda; R Nair; A I Reed; C P Thomas

doi:10.1016/j.transproceed.2012.03.053

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Case report: Eculizumab rescue of severe accelerated antibody-mediated rejection after ABO-incompatible kidney transplant

Journal article

Peer reviewed

Case report: Eculizumab rescue of severe accelerated antibody-mediated rejection after ABO-incompatible kidney transplant

Z A Stewart, T E Collins, A J Schlueter, T I Raife, D G Holanda, R Nair, A I Reed and C P Thomas

Transplantation proceedings, Vol.44(10), pp.3033-3036

12/2012

DOI: 10.1016/j.transproceed.2012.03.053

PMID: 23195021

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Abstract

ABO-incompatible (ABOI) living donor kidney transplantation has become a well-accepted practice with standard protocols using perioperative antibody-depleting therapies to lower blood group titers to an acceptable threshold for transplantation. However, a subset of patients will experience accelerated antibody-mediated rejection (AMR) after ABOI kidney transplantation and require aggressive intervention to prevent allograft loss. Here in we report the successful use of terminal complement inhibition with eculizumab to rescue an ABOI kidney allograft with accelerated AMR refractory to salvage splenectomy and daily plasmapheresis. This case emphasizes the fact that, despite close postoperative surveillance and aggressive intervention, graft loss from accelerated AMR after ABOI kidney transplantation remains a very real risk. Eculizumab may offer a graft-saving therapeutic option for isolated cases of severe AMR after ABOI kidney transplantation refractory to standard treatment.

Severity of Illness Index

Graft Rejection - drug therapy

Antibodies, Monoclonal, Humanized - therapeutic use

Humans

Immunosuppressive Agents - therapeutic use

Male

Treatment Outcome

Blood Group Incompatibility - blood

Blood Group Incompatibility - immunology

Plasmapheresis

Splenectomy

Immunoglobulins, Intravenous - therapeutic use

Time Factors

Immunity, Humoral - drug effects

Adult

ABO Blood-Group System - immunology

Graft Rejection - immunology

Graft Survival - drug effects

Kidney Transplantation - immunology

Histocompatibility

Complement Activation - drug effects

Kidney Transplantation - adverse effects

Details

Title: Subtitle: Case report: Eculizumab rescue of severe accelerated antibody-mediated rejection after ABO-incompatible kidney transplant
Creators: Z A Stewart - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. zoe-stewart@uiowa.edu
T E Collins
A J Schlueter
T I Raife
D G Holanda
R Nair - University of Iowa
A I Reed
C P Thomas
Resource Type: Journal article
Publication Details: Transplantation proceedings, Vol.44(10), pp.3033-3036
Publisher: United States
DOI: 10.1016/j.transproceed.2012.03.053
PMID: 23195021
ISSN: 0041-1345
eISSN: 1873-2623
Language: English
Date published: 12/2012
Academic Unit: Stead Family Department of Pediatrics; Pathology; Accounting; Surgery; Obstetrics and Gynecology; Nephrology; Internal Medicine
Record Identifier: 9983986084302771

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