Eculizumab and splenectomy as salvage therapy for severe antibody-mediated rejection after HLA-incompatible kidney transplantation.

Academic Article

Abstract

  • BACKGROUND: Incompatible live donor kidney transplantation is associated with an increased rate of antibody-mediated rejection (AMR) and subsequent transplant glomerulopathy. For patients with severe, oliguric AMR, graft loss is inevitable without timely intervention. METHODS: We reviewed our experience rescuing kidney allografts with this severe AMR phenotype by using splenectomy alone (n=14), eculizumab alone (n=5), or splenectomy plus eculizumab (n=5), in addition to plasmapheresis. RESULTS: The study population was 267 consecutive patients with donor-specific antibody undergoing desensitization. In the first 3 weeks after transplantation (median=6 days), 24 patients developed sudden onset oliguria and rapidly rising serum creatinine with marked rebound of donor-specific antibody, and a biopsy that showed features of AMR. At a median follow-up of 533 days, 4 of 14 splenectomy-alone patients experienced graft loss (median=320 days), compared to four of five eculizumab-alone patients with graft failure (median=95 days). No patients treated with splenectomy plus eculizumab experienced graft loss. There was more chronic glomerulopathy in the splenectomy-alone and eculizumab-alone groups at 1 year, whereas splenectomy plus eculizumab patients had almost no transplant glomerulopathy. CONCLUSION: These data suggest that for patients manifesting early severe AMR, splenectomy plus eculizumab may provide an effective intervention for rescuing and preserving allograft function.
  • Published In

  • Transplantation  Journal
  • Keywords

  • Adult, Aged, Antibodies, Monoclonal, Humanized, Biopsy, Female, Graft Rejection, Histocompatibility Testing, Humans, Isoantibodies, Kidney, Kidney Transplantation, Male, Middle Aged, Postoperative Complications, Salvage Therapy, Splenectomy
  • Digital Object Identifier (doi)

    Author List

  • Orandi BJ; Zachary AA; Dagher NN; Bagnasco SM; Garonzik-Wang JM; Van Arendonk KJ; Gupta N; Lonze BE; Alachkar N; Kraus ES
  • Start Page

  • 857
  • End Page

  • 863
  • Volume

  • 98
  • Issue

  • 8