A Case of Acute Antibody-Mediated Rejection Developed after Pretreatment with Rituximab and Plasma Exchange in a Highly-Sensitized Recipient with a Deceased Donor Kidney.
10.4285/jkstn.2012.26.2.125
- Author:
Seong Min KIM
1
;
Joon Seok OH
;
Yong Hun SIN
;
Joong Kyung KIM
;
Jong In PARK
;
Kill HUH
;
Yong Jin KIM
Author Information
1. Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea. kidney119@hotmail.com
- Publication Type:Case Report
- Keywords:
Kidney transplantation;
Cadaver;
Rituximab;
Graft rejection;
Immunization
- MeSH:
Antibodies, Monoclonal;
Antibodies, Monoclonal, Murine-Derived;
Biopsy;
Cadaver;
Centers for Disease Control and Prevention (U.S.);
Creatinine;
Early Diagnosis;
Graft Rejection;
Humans;
Immunization;
Kidney;
Kidney Transplantation;
Mycophenolic Acid;
Plasma;
Plasma Exchange;
Prednisolone;
Recombinant Fusion Proteins;
Rejection (Psychology);
Rituximab;
Steroids;
Tacrolimus;
Tissue Donors;
Transplants
- From:The Journal of the Korean Society for Transplantation
2012;26(2):125-130
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Acute antibody-mediated rejection is the major cause of graft failure in the early stage of kidney transplantation. Preoperative treatment and early diagnosis of acute rejection is very important to prevent graft loss in sensitized patients. High panel reactive antibody (PRA) means a likelihood of acute rejection, and the recipient of high PRA needs adequate pretreatment for kidney transplantation. However, there is not sufficient time and chances for desensitization in deceased kidney transplants. We report a successful renal transplant outcome in a 47-year-old-woman with high PRA levels (Class I 97.5%, Class II 36.7%). The cross match was negative on the CDC (ELISA) and flowcytometric methods. Plasma exchange was performed on the recipient before transplantation (fresh frozen plasma replacement, 1.3 plasma volume) and immediately after plasma exchange she was given 200 mg of rituximab. She received basiliximab and methyl prednisolone induction therapy and was maintained on steroids, mycophenolate mofetil, and tacrolimus. Graft function was normal immediately after transplantation, but decreased urinary output and elevated serum creatinine was noted on POD 5. On POD 6, a graft biopsy revealed acute cellular rejection (Type IIa) and antibody-mediated rejection (Type II). On 9~13 days after transplantation, additional plasma exchange was performed every other day, and steroid pulse therapy was performed 3 times. After normalization of urinary output and serum creatinine, the patient was discharged and is being followed up on. In conclusion, immunologically careful preparation and pretransplant treatment may be needed on the negative cross match in cadaveric kidney recipients with high levels of PRA.
