title: Prompt reversal of a severe complement activation by eculizumab in a patient undergoing intentional ABO-incompatible pancreas and kidney transplantation.
abstract: We describe the presumably first intentional ABO-incompatible deceased-donor kidney and pancreas transplantation with a severe antibody-mediated rejection during a rebound of isoagglutinins. Rejection was successfully treated with eculizumab, which inhibits the terminal pathway of complement. Complement analysis (C3, C3d,g, and a modified assay of classical complement-related hemolytic function) documented complement activation and confirmed that eculizumab completely blocked complement function. At 6 months, the patient had normal kidney and pancreas function, and histological evaluations revealed no evidence of sustained graft damage. This successful transplantation suggests that ABO barriers can safely be overcome without extensive preconditioning, when the complement inhibitor eculizumab is included.
authors.affiliation: Section of Transplantation Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. alireza.biglarnia@akademiska.se
authors.forename: Ali-Reza
authors.initials: AR
authors.lastname: Biglarnia
authors.forename: Bo
authors.initials: B
authors.lastname: Nilsson
authors.forename: Thomas
authors.initials: T
authors.lastname: Nilsson
authors.forename: Bengt
authors.initials: B
authors.lastname: von Zur-Mühlen
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Christian
authors.initials: C
authors.lastname: Berne
authors.forename: Alkwin
authors.initials: A
authors.lastname: Wanders
authors.forename: Anders
authors.initials: A
authors.lastname: Magnusson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tufveson
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000494:pharmacology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D003167:Complement Activation; D003165:Complement System Proteins; D003920:Diabetes Mellitus / Q000628:therapy; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D006801:Humans; D016130:Immunophenotyping / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods*; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*
chemical_list: D000017:ABO Blood-Group System; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D003165:Complement System Proteins; C481642:eculizumab