title: Successful management of antibody-mediated rejection after cardiac transplantation in a patient supported by a left ventricular assist device for more than 3 years.
abstract: Due to donor shortage, patients with refractory heart failure need to be supported on mechanical circulatory support (MCS). Critically, patients undergo several deployments of MCS in stages inevitably requiring blood products transfusion. MCSs per se along with blood products can trigger immune allosensitization. Antibody-mediated rejection (AMR) is associated with significant mortality after heart transplantation. Here, we present the case with high panel-reactive antibody over 95% who developed AMR early after heart transplantation. This life-threatening complication was successfully treated with multi-modal treatment including anti-CD20 antibody, rituximab.
authors.affiliation: Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan. akiyamam@med.tohoku.ac.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Akiyama
authors.affiliation: Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Takahara
authors.affiliation: Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawatsu
authors.affiliation: Physiological Laboratory Center, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Endo
authors.affiliation: Physiological Laboratory Center, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Fujiwara
authors.affiliation: Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Adachi
authors.affiliation: Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Kumagai
authors.affiliation: Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kawamoto
authors.affiliation: Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Saiki
mesh_terms: D000906:Antibodies / Q000276:immunology*; D004452:Echocardiography; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006353:Heart-Assist Devices; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008875:Middle Aged; D000069283:Rituximab / Q000627:therapeutic use*
chemical_list: D000906:Antibodies; D007155:Immunologic Factors; D000069283:Rituximab
keywords: Antibody-mediated rejection; Heart transplantation; Left ventricular assist device; Panel-reactive antibody; Rituximab