Successful treatment of early acute antibody-mediated rejection in an human leukocyte antigen-incompatible and ABO-incompatible living-donor kidney transplant patient.
Desensitization
Human leukocyte antigen
Kidney transplantation
Living donor
Rejection
Journal
Korean journal of transplantation
ISSN: 2671-8790
Titre abrégé: Korean J Transplant
Pays: Korea (South)
ID NLM: 101775609
Informations de publication
Date de publication:
31 Dec 2019
31 Dec 2019
Historique:
received:
12
11
2019
revised:
17
12
2019
accepted:
19
12
2019
entrez:
30
6
2022
pubmed:
31
12
2019
medline:
31
12
2019
Statut:
ppublish
Résumé
For successful human leukocyte antigen-incompatible (HLAi) or ABO-incompatible (ABOi) living-donor kidney transplantations (LDKTs), pretransplant desensitization is essential; however, early antibody-mediated rejection (ABMR) remains the most important complication after HLAi or ABOi transplantation. Here, we report a case of early acute ABMR in simultaneous HLAi and ABOi LDKT with preformed donor-specific antibody (DSA), despite desensitization. Dialysis-dependent, severe ABMR occurred with a rebound of pre-existing DSA and appearance of de novo DSA after initial normalization of renal function, 8 days postoperatively. However, a low anti-ABO antibody titer (1:8) was maintained after transplantation. Combination therapy of plasmapheresis, high-dose intravenous immunoglobulin, and bortezomib improved both ABMR and renal functions. Thus, an appropriate preventive and therapeutic management for early ABMR is important among high-risk LDKT patients. Furthermore, early AMBR can occur despite pretransplant desensitization as seen in this case, and close monitoring of the patient and prompt management are considered vital for better therapeutic outcomes.
Identifiants
pubmed: 35769976
doi: 10.4285/jkstn.2019.33.4.153
pii: KJT-33-4-153
pmc: PMC9188936
doi:
Types de publication
Case Reports
Langues
eng
Pagination
153-158Informations de copyright
Copyright: © 2019 The Korean Society for Transplantation.
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