Premium
Plasmapheresis‐resistant acute humoral rejection successfully treated with anti‐C5 antibody
Author(s) -
Ghirardo Giulia,
Benetti Elisa,
Poli Francesca,
Vidal Enrico,
Della Vella Manuela,
Cozzi Emanuele,
Murer Luisa
Publication year - 2014
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12187
Subject(s) - medicine , eculizumab , plasmapheresis , desensitization (medicine) , transplantation , kidney transplantation , methylprednisolone , peritubular capillaries , biopsy , surgery , urology , antibody , gastroenterology , immunology , complement system , receptor
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‐ DQ 5 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 .