Eculizumab to treat antibody-mediated rejection in a 7-year-old kidney transplant recipient.

Détails

ID Serval
serval:BIB_2A471BDF7098
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Etude de cas (case report): rapporte une observation et la commente brièvement.
Collection
Publications
Titre
Eculizumab to treat antibody-mediated rejection in a 7-year-old kidney transplant recipient.
Périodique
Pediatrics
Auteur(s)
Chehade H., Rotman S., Matter M., Girardin E., Aubert V., Pascual M.
ISSN
1098-4275 (Electronic)
ISSN-L
0031-4005
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
135
Numéro
2
Pages
e551-e555
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish, pdf : Case Report
Résumé
We report on successful early eculizumab administration to treat acute antibody-mediated rejection (ABMR) in a highly sensitized kidney transplant recipient. The recipient is a 7-year-old boy who received, 6 months after a desensitization protocol with monthly intravenous immunoglobulin infusion, a second kidney transplant in the presence of low donor-specific antibodies (DSAs). Both pretransplant lymphocytotoxic and flow cytometric crossmatch were negative. Allograft function recovered promptly, with excellent initial function. On postoperative day (POD) 4, the child developed significant proteinuria with an acute rise in serum creatinine. Allograft biopsy showed severe acute ABMR. Intravenous eculizumab (600 mg), preceded by a single session of plasmapheresis, was administered on POD 5 and 12 along with a 4-day thymoglobulin course. After the first dose of eculizumab, a strikingly rapid normalization of allograft function with a decrease in proteinuria occurred. However, because circulating DSA levels remained elevated, the child received 3 doses of intravenous immunoglobulin (POD 15, 16, and 17), with a significant subsequent decrease in DSA levels. At 9 months after transplant, the child continues to maintain excellent allograft function with undetectable circulating DSA levels. This unique case highlights the potential efficacy of using early eculizumab to rapidly reverse severe ABMR in pediatric transplantation, and therefore it suggests a novel therapeutic approach to treat acute ABMR.
Pubmed
Web of science
Open Access
Oui
Création de la notice
28/01/2015 14:41
Dernière modification de la notice
20/08/2019 13:09
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