Plasmapheresis-resistant acute humoral rejection successfully treated with anti-C5 antibody
Version of Record online: 25 NOV 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Volume 18, Issue 1, pages E1–E5, February 2014
How to Cite
Plasmapheresis-resistant acute humoral rejection successfully treated with anti-C5 antibody., , , , , , .
- Issue online: 3 JAN 2014
- Version of Record online: 25 NOV 2013
- Manuscript Accepted: 26 SEP 2013
- sensitized transplant recipient
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.