Plasmapheresis‐resistant acute humoral rejection successfully treated with anti‐C5 antibody. (25th November 2013)

• Record Type: Journal Article
• Authors: Ghirardo, Giulia; Benetti, Elisa; Poli, Francesca; Vidal, Enrico; Della Vella, Manuela; Cozzi, Emanuele; Murer, Luisa
• Is Part Of: Pediatric transplantation. Volume 18:Number 1(2014:Feb.)
• Page Start: E1
• Page End: E5
• Publication Date: 2013-11-25
• Subjects: Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.12187
• Languages: English
• ISSNs: 1397-3142

Abstract

<abstract abstract-type="main" id="petr12187-abs-0001"> <title>Abstract</title> <p>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.</p> </abstract>