Eculizumab Salvage Therapy for Antibody-Mediated Rejection in a Desensitization-Resistant Intestinal Re-Transplant Patient

J. Fan, Panagiotis Tryphonopoulos, A. Tekin, Seigo Nishida, G. Selvaggi, A. Amador, J. Jebrock, D. Weppler, D. Levi, R. Vianna, P. Ruiz, A. Tzakis

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

The presence of elevated calculated panel reactive antibody (cPRA) and anti-HLA donor specific antibodies (DSA) are high risk factors for acute antibody-mediated rejection (AAMR) in intestinal transplantation that may lead to graft loss. Eculizumab has been used for the treatment of AAMR in kidney transplantation of sensitized patients that do not respond to other treatment. Here, we report a case where eculizumab was used to treat AAMR in a desensitization-resistant intestinal re-transplant patient. A male patient lost his intestinal graft to AAMR 8.14 years after his primary transplant. He received a second intestinal graft that had to be explanted a month later due to refractory AAMR. The patient remained highly sensitized despite multiple treatments. He received a multivisceral graft and presented with severe AAMR on day 3 posttransplantation. The AAMR was successfully treated with eculizumab. The patient presently maintains an elevated cPRA level above 90% but his DSAs have decreased from 18-000 MFI (mean fluorescent intensity) to below the positive cut-off value of 3000 MFI and remains rejection free with a 2-year follow-up since his multivisceral transplant. Eculizumab offers an alternative to treat AAMR in intestinal transplantation in desensitization-resistant patients. The authors report a case in which eculizumab, a humanized monoclonal antibody against complement C5, was used to treat acute antibody-mediated rejection in a desensitization-resistant intestinal re-transplant patient.

Original languageEnglish (US)
Pages (from-to)1995-2000
Number of pages6
JournalAmerican Journal of Transplantation
Volume15
Issue number7
DOIs
StatePublished - Jul 1 2015

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

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