title: Case report: Eculizumab rescue of severe accelerated antibody-mediated rejection after ABO-incompatible kidney transplant.
abstract: ABO-incompatible (ABOI) living donor kidney transplantation has become a well-accepted practice with standard protocols using perioperative antibody-depleting therapies to lower blood group titers to an acceptable threshold for transplantation. However, a subset of patients will experience accelerated antibody-mediated rejection (AMR) after ABOI kidney transplantation and require aggressive intervention to prevent allograft loss. Here in we report the successful use of terminal complement inhibition with eculizumab to rescue an ABOI kidney allograft with accelerated AMR refractory to salvage splenectomy and daily plasmapheresis. This case emphasizes the fact that, despite close postoperative surveillance and aggressive intervention, graft loss from accelerated AMR after ABOI kidney transplantation remains a very real risk. Eculizumab may offer a graft-saving therapeutic option for isolated cases of severe AMR after ABOI kidney transplantation refractory to standard treatment.
authors.affiliation: Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. zoe-stewart@uiowa.edu
authors.forename: Z A
authors.initials: ZA
authors.lastname: Stewart
authors.forename: T E
authors.initials: TE
authors.lastname: Collins
authors.forename: A J
authors.initials: AJ
authors.lastname: Schlueter
authors.forename: T I
authors.initials: TI
authors.lastname: Raife
authors.forename: D G
authors.initials: DG
authors.lastname: Holanda
authors.forename: R
authors.initials: R
authors.lastname: Nair
authors.forename: A I
authors.initials: AI
authors.lastname: Reed
authors.forename: C P
authors.initials: CP
authors.lastname: Thomas
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001787:Blood Group Incompatibility / Q000097:blood / Q000276:immunology*; D003167:Complement Activation / Q000187:drug effects; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006085:Graft Survival / Q000187:drug effects; D006648:Histocompatibility; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D010956:Plasmapheresis; D012720:Severity of Illness Index; D013156:Splenectomy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D061067:Antibodies, Monoclonal, Humanized; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; C481642:eculizumab