Successful treatment of cardiogenic shock caused by humoral cardiac allograft rejection.
The progress of immunosuppressive therapy has made heart transplantation the standard therapy for end-stage heart failure. However, humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. The present patient developed profound cardiogenic shock requiring extracorporeal life support on the 8th day after heart transplantation. Endomyocardial biopsy revealed no cellular rejection, and complement component C4d was positively stained on the capillary endothelium. The patient was successfully treated with repeated plasmapheresis and administration of anti-CD20 monoclonal antibody, rituximab, as well as with steroid pulse and increased standard immunosuppressive medication.
Saito
Shunsuke
S
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Matsumiya
Goro
G
Fukushima
Norihide
N
Sakaguchi
Taichi
T
Fujita
Tomoyuki
T
Ueno
Takayoshi
T
Miyagawa
Shuji
S
Yamauchi
Amane
A
Sawa
Yoshiki
Y
D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000917:Antibody Formation; D001706:Biopsy; D002196:Capillaries / Q000276:immunology; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D015935:Complement C4b / Q000378:metabolism; D004359:Drug Therapy, Combination; D004699:Endocardium / Q000276:immunology; D015199:Extracorporeal Membrane Oxygenation; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000276:immunology; D010446:Peptide Fragments / Q000378:metabolism; D010956:Plasmapheresis; D020551:Pulse Therapy, Drug; D000069283:Rituximab; D012770:Shock, Cardiogenic / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D013256:Steroids / Q000008:administration & dosage; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D010446:Peptide Fragments; D013256:Steroids; D000069283:Rituximab; D015935:Complement C4b; C032261:complement C4d