title: Eculizumab treatment of acute antibody-mediated rejection in renal transplantation: case reports.
abstract: The occurrence of acute antibody-mediated rejection (AMR), especially in more severe cases, continues to be associated with a poor prognosis for implant survival. Here, we have reported the results of treatment of two patients who developed AMR associated with thrombotic microangiopathy immediately after transplantation. We used a single dose of eculizumab at an early stage jointly with conventional modalities of steroid boluses, plasmapheresis, intravenous immunoglobulin, and rituximab. In both cases, the clinical course was favorable. Eculizumab, a monoclonal antibody with a high affinity for complement protein C5, prevents generation of the final membrane attack complex, blocking this cascade. To date, there are a few reports of the usefulness of eculizumab in AMR. Eculizumab can help to stop endothelial damage, especially in severe cases that show a risk of progression to cortical necrosis, by providing a therapeutic window until the other modalities begin to control the immune response. In our experience, the use of eculizumab can be beneficial in the treatment of AMR.
authors.affiliation: Unidad Gestión Clínica de Nefrourología, Hospitales Universitarios Virgen del Rocío), Sevilla, Spain. fmgonzalezr@senefro.org
authors.forename: F
authors.initials: F
authors.lastname: González-Roncero
authors.forename: M
authors.initials: M
authors.lastname: Suñer
authors.forename: G
authors.initials: G
authors.lastname: Bernal
authors.forename: V
authors.initials: V
authors.lastname: Cabello
authors.forename: M
authors.initials: M
authors.lastname: Toro
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.forename: M
authors.initials: M
authors.lastname: Angel Gentil
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab; D013256:Steroids / Q000627:therapeutic use; D057049:Thrombotic Microangiopathies / Q000276:immunology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D013256:Steroids; D000069283:Rituximab; C481642:eculizumab