title: Successful rescue of refractory, severe antibody mediated rejection with splenectomy.
abstract: Antibody-mediated rejection (AMR) commonly occurs after transplantation of ABO-incompatible and sensitized renal transplant. Treatment regimens commonly include a combination of plasmapheresis (PL) and intravenous immunoglobulin (IVIG). However, some cases of AMR remain refractory to treatment. We report a case series of four patients with AMR refractory to standard therapy (ST) who resolved after splenectomy. Four living donor kidney transplant recipients were diagnosed with AMR. Two patients were ABO incompatible, one was cross-match positive and one had no obvious predisposing factors. After failure of therapy with corticosteroids, PL, IVIG, Thymoglobulin, and Rituximab (three patients) or Campath (one patient), AMR was treated with laparoscopic splenectomy. After an average of 11 days of ST, laparoscopic splenectomy was performed for rescue. The urinary output improved immediately in all patients, serum creatinine levels decreased within 48 hr, and ABO titers fell in the ABO-incompatible patient and the cross-match became negative in the two sensitized patients. Splenectomy may play a role in the treatment of AMR refractory to ST.
authors.affiliation: Division of Transplant Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA. kaplanb@uic.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
authors.forename: Antonio
authors.initials: A
authors.lastname: Gangemi
authors.forename: James
authors.initials: J
authors.lastname: Thielke
authors.forename: José
authors.initials: J
authors.lastname: Oberholzer
authors.forename: Howard
authors.initials: H
authors.lastname: Sankary
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
mesh_terms: D000328:Adult; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006650:Histocompatibility Testing; D006801:Humans; D013154:Spleen / Q000276:immunology* / Q000473:pathology; D013156:Splenectomy; D016896:Treatment Outcome
chemical_list: D003404:Creatinine