title: Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation.
abstract: Acute humoral rejection (AHR) is uncommon after ABO-compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Liver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab. Liver enzymes returned to within normal range 18 d after diagnosis. Liver biopsies, at 3 and 9 mo post-transplant, showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.
authors.affiliation: Department of Nephrology, Dialysis and Multi-organ Transplantation, CHU Rangueil, TSA 50032, 31059 Toulouse Cedex 9, France. kamar.n@chu-toulouse.fr
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Laurence
authors.initials: L
authors.lastname: Lavayssière
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.forename: Janick
authors.initials: J
authors.lastname: Selves
authors.forename: Céline
authors.initials: C
authors.lastname: Guilbeau-Frugier
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cardeau
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.forename: Olivier
authors.initials: O
authors.lastname: Cointault
authors.forename: Marie Béatrice
authors.initials: MB
authors.lastname: Nogier
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Peron
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Marylise
authors.initials: M
authors.lastname: Fort
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001787:Blood Group Incompatibility / Q000276:immunology / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology / Q000628:therapy; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab