title: The use of antibody to complement protein C5 for salvage treatment of severe antibody-mediated rejection.
abstract: Desensitized patients are at high risk of developing acute antibody-mediated rejection (AMR). In most cases, the rejection episodes are mild and respond to a short course of plasmapheresis (PP) / low-dose IVIg treatment. However, a subset of patients experience severe AMR associated with sudden onset oliguria. We previously described the utility of emergent splenectomy in rescuing allografts in patients with this type of severe AMR. However, not all patients are good candidates for splenectomy. Here we present a single case in which eculizumab, a complement protein C5 antibody that inhibits the formation of the membrane attack complex (MAC), was used combined with PP/IVIg to salvage a kidney undergoing severe AMR. We show a marked decrease in C5b-C9 (MAC) complex deposition in the kidney after the administration of eculizumab.
authors.affiliation: Deparmtent of Surgery, John Hopkins Medical Institutions, John Hopkins University, Baltimore, MD, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Locke
authors.forename: C M
authors.initials: CM
authors.lastname: Magro
authors.forename: A L
authors.initials: AL
authors.lastname: Singer
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
authors.forename: M
authors.initials: M
authors.lastname: Haas
authors.forename: A T
authors.initials: AT
authors.lastname: Hillel
authors.forename: K E
authors.initials: KE
authors.lastname: King
authors.forename: E
authors.initials: E
authors.lastname: Kraus
authors.forename: L M
authors.initials: LM
authors.lastname: Lees
authors.forename: J K
authors.initials: JK
authors.lastname: Melancon
authors.forename: Z A
authors.initials: ZA
authors.lastname: Stewart
authors.forename: D S
authors.initials: DS
authors.lastname: Warren
authors.forename: A A
authors.initials: AA
authors.lastname: Zachary
authors.forename: R A
authors.initials: RA
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003182:Complement C5 / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D016879:Salvage Therapy
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003182:Complement C5; D016756:Immunoglobulins, Intravenous; C481642:eculizumab