Plasmapheresis-resistant acute humoral rejection successfully treated with anti-C5 antibody

Giulia Ghirardo, Elisa Benetti, Francesca Poli, Enrico Vidal, Manuela Della Vella, Emanuele Cozzi, Luisa Murer

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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.

Original languageEnglish
JournalPediatric Transplantation
Volume18
Issue number1
DOIs
Publication statusPublished - Feb 2014

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Keywords

  • eculizumab
  • pediatric
  • plasmapheresis
  • sensitized transplant recipient

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Ghirardo, G., Benetti, E., Poli, F., Vidal, E., Della Vella, M., Cozzi, E., & Murer, L. (2014). Plasmapheresis-resistant acute humoral rejection successfully treated with anti-C5 antibody. Pediatric Transplantation, 18(1). https://doi.org/10.1111/petr.12187