title: Four-year allograft survival in a highly sensitized combined liver-kidney transplant patient despite unsuccessful anti-HLA antibody reduction with rituximab, splenectomy, and bortezomib.
abstract: Although donor-specific lymphocytotoxic antibodies are regarded as a contraindication for kidney transplantation (KTx), the data available for liver or combined liver or kidney transplantation (cLKTx) are scarce. Here, we report a case of a highly sensitized young man receiving his sixth liver and second kidney graft. Multiple anti-HLA antibodies were present at the time of transplantation. As a result of suspected antibody-mediated graft damage, the patient was treated with rituximab, plasmapheresis, intravenous immunoglobulins, splenectomy, and bortezomib to decrease the antibody production. So far, patient and allograft survival has reached 4 years despite failure to achieve a permanent reduction of anti-HLA antibodies, and particularly nondonor directed antibodies.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, UKE, Hamburg, Germany. martina.koch@uke.de
authors.forename: Martina
authors.initials: M
authors.lastname: Koch
authors.forename: Christian
authors.initials: C
authors.lastname: Gräser
authors.forename: Anja
authors.initials: A
authors.lastname: Lehnhardt
authors.forename: Jörg M
authors.initials: JM
authors.lastname: Pollok
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Murielle
authors.initials: M
authors.lastname: Verboom
authors.forename: Friedrich
authors.initials: F
authors.lastname: Thaiss
authors.forename: Thomas
authors.initials: T
authors.lastname: Eiermann
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D010956:Plasmapheresis; D011719:Pyrazines / Q000627:therapeutic use*; D000069283:Rituximab; D013156:Splenectomy
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D011719:Pyrazines; D000069283:Rituximab; D000069286:Bortezomib
keywords: anti-HLA antibodies; bortezomib; combined liver-kidney transplantation; rituximab; splenectomy