Upfront use of eculizumab to treat early acute antibody-mediated rejection after kidney allotransplantation and relevance for xenotransplantation.

Details

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State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_119F4B750A1D
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Upfront use of eculizumab to treat early acute antibody-mediated rejection after kidney allotransplantation and relevance for xenotransplantation.
Journal
Xenotransplantation
Author(s)
Schwotzer N., Paganetti G., Barchi M., Perrottet N., Aubert V., Sadallah S., Rotman S., Venetz J.P., Matter M., Golshayan D., Pascual M.
ISSN
1399-3089 (Electronic)
ISSN-L
0908-665X
Publication state
Published
Issued date
07/2020
Peer-reviewed
Oui
Volume
27
Number
4
Pages
e12630
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Acute antibody-mediated rejection (AMR) early after transplant remains a challenge, both in allotransplantation and in xenotransplantation. We report the case of an early and severe acute AMR episode in a kidney transplant recipient that was successfully treated with upfront eculizumab. A 58-year-old woman had been on dialysis since 2014. She underwent a first kidney transplant in 2018 with primary non-function and received several blood transfusions. Postoperatively, she developed anti-HLA antibodies. One year later, she received a second allograft from a deceased donor. At day 0, there was only one preformed low-level donor-specific antibody (DSA) anti-DQ7. After initial excellent allograft function, serum creatinine increased on days 7-9, and this was associated with oligo-anuria. On day 7, there was an increase in her DSA anti-DQ7 and 4 de novo DSA had developed at high MFI values. Allograft biopsy showed severe active AMR with diffuse C4d deposits in peritubular capillaries. The early acute AMR episode was treated with upfront eculizumab administration (2 doses) with efficient CH50 blockade (< 10% CH50). Rituximab was also administered on day 12, and intravenous immunoglobulin (IVIG) was given over the following days. There was an excellent clinical response to eculizumab administration. Eculizumab administration rapidly reversed the acute AMR episode without the need for plasmapheresis. Rituximab and IVIG were also used as B-cell immunomodulators to decrease DSA. Blocking efficiently the terminal complement pathway may become a useful strategy to treat acute AMR in sensitized recipients of allografts, and possibly in recipients of discordant xenografts.
Keywords
Immunology, Transplantation, antibody-mediated rejection, eculizumab, kidney allotransplantation, xenotransplantation
Pubmed
Web of science
Open Access
Yes
Create date
24/07/2020 13:33
Last modification date
12/01/2021 8:08
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