title: Plasmapheresis-resistant acute humoral rejection successfully treated with anti-C5 antibody.
abstract: Even if kidney graft survival has improved during the last decades, sensitized pediatric patients are an emerging problem. We describe a 17-yr-old male who lost his first graft due to chronic rejection becoming hyperimmunized (CDC PRA 99.61%). A desensitization protocol based on high-dose IVIG, PP, and two Mabthera(®) infusions was performed with minor response (CDC PRA post-desensitization 80%). One month after his second non-living transplant, he developed a biopsy-proven AMR; post-transplant immunological monitoring showed the presence of donor-specific anti-DQ5 antibodies (DSA, MFI 20.000). He received methylprednisolone pulses and 45 PP sessions without clinical response; eculizumab was then used to salvage a kidney undergoing severe PP-resistant rejection. A biopsy performed after the fourth eculizumab infusion showed complete resolution of AMR. Eculizumab infusions were then continued for the first year post-transplantation. Two yr after transplantation, graft function is stable. Anti-C5 therapy may represent an effective therapeutic option in pediatric patients with PP-resistant AMR.
authors.affiliation: Pediatric Nephrology, Dialysis and Transplant Unit, Department of Pediatrics, University Hospital of Padua, Padua, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ghirardo
authors.forename: Elisa
authors.initials: E
authors.lastname: Benetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Poli
authors.forename: Enrico
authors.initials: E
authors.lastname: Vidal
authors.forename: Manuela
authors.initials: M
authors.lastname: Della Vella
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cozzi
authors.forename: Luisa
authors.initials: L
authors.lastname: Murer
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000737:chemistry*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D003182:Complement C5 / Q000276:immunology; D006084:Graft Rejection / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D056724:Immunity, Humoral; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009404:Nephrotic Syndrome / Q000151:congenital / Q000628:therapy; D010956:Plasmapheresis; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D061067:Antibodies, Monoclonal, Humanized; D003182:Complement C5; C481642:eculizumab; D008775:Methylprednisolone
keywords: eculizumab; pediatric; plasmapheresis; sensitized transplant recipient