title: Eculizumab to treat antibody-mediated rejection in a 7-year-old kidney transplant recipient.
abstract: We report on successful early eculizumab administration to treat acute antibody-mediated rejection (ABMR) in a highly sensitized kidney transplant recipient. The recipient is a 7-year-old boy who received, 6 months after a desensitization protocol with monthly intravenous immunoglobulin infusion, a second kidney transplant in the presence of low donor-specific antibodies (DSAs). Both pretransplant lymphocytotoxic and flow cytometric crossmatch were negative. Allograft function recovered promptly, with excellent initial function. On postoperative day (POD) 4, the child developed significant proteinuria with an acute rise in serum creatinine. Allograft biopsy showed severe acute ABMR. Intravenous eculizumab (600 mg), preceded by a single session of plasmapheresis, was administered on POD 5 and 12 along with a 4-day thymoglobulin course. After the first dose of eculizumab, a strikingly rapid normalization of allograft function with a decrease in proteinuria occurred. However, because circulating DSA levels remained elevated, the child received 3 doses of intravenous immunoglobulin (POD 15, 16, and 17), with a significant subsequent decrease in DSA levels. At 9 months after transplant, the child continues to maintain excellent allograft function with undetectable circulating DSA levels. This unique case highlights the potential efficacy of using early eculizumab to rapidly reverse severe ABMR in pediatric transplantation, and therefore it suggests a novel therapeutic approach to treat acute ABMR.
authors.affiliation: Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland; hassib.chehade@chuv.ch.
authors.forename: Hassib
authors.initials: H
authors.lastname: Chehade
authors.affiliation: Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland; and.
authors.forename: Samuel
authors.initials: S
authors.lastname: Rotman
authors.affiliation: Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland; and.
authors.forename: Maurice
authors.initials: M
authors.lastname: Matter
authors.affiliation: Children's Hospital, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Girardin
authors.affiliation: Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland; and.
authors.forename: Vincent
authors.initials: V
authors.lastname: Aubert
authors.affiliation: Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland; and.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
mesh_terms: D000208:Acute Disease; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D003888:Desensitization, Immunologic; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007116:Immunization, Passive; D007518:Isoantibodies / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D010956:Plasmapheresis; D012086:Reoperation; D014181:Transplantation Immunology / Q000276:immunology*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D006680:HLA Antigens; D007518:Isoantibodies; C481642:eculizumab
keywords: acute humoral rejection; case report; eculizumab; infant; kidney transplant