Plasmapheresis-resistant acute humoral rejection successfully treated with anti-C5 antibody.

Abstract:

:Even if kidney graft survival has improved during the last decades, sensitized pediatric patients are an emerging problem. We describe a 17-yr-old male who lost his first graft due to chronic rejection becoming hyperimmunized (CDC PRA 99.61%). A desensitization protocol based on high-dose IVIG, PP, and two Mabthera(®) infusions was performed with minor response (CDC PRA post-desensitization 80%). One month after his second non-living transplant, he developed a biopsy-proven AMR; post-transplant immunological monitoring showed the presence of donor-specific anti-DQ5 antibodies (DSA, MFI 20.000). He received methylprednisolone pulses and 45 PP sessions without clinical response; eculizumab was then used to salvage a kidney undergoing severe PP-resistant rejection. A biopsy performed after the fourth eculizumab infusion showed complete resolution of AMR. Eculizumab infusions were then continued for the first year post-transplantation. Two yr after transplantation, graft function is stable. Anti-C5 therapy may represent an effective therapeutic option in pediatric patients with PP-resistant AMR.

journal_name

Pediatr Transplant

authors

Ghirardo G,Benetti E,Poli F,Vidal E,Della Vella M,Cozzi E,Murer L

doi

10.1111/petr.12187

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

E1-5

issue

1

eissn

1397-3142

issn

1399-3046

journal_volume

18

pub_type

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