The utility of splenectomy as rescue treatment for severe acute antibody mediated rejection.

Academic Article

Abstract

  • Antibody-mediated rejection (AMR) after desensitization for a positive crossmatch (+XM) live donor renal transplant can be severe and result in sudden onset oliguria and loss of the allograft. Attempts to rescue these kidneys using plasmapheresis (PP) and IVIg may be ineffective due to the magnitude of antibody burden that must be controlled to prevent renal thrombosis or cortical necrosis. We review our experience using splenectomy combined with PP/IVIg as rescue therapy for patients experiencing an acute deterioration in renal function and a rise in donor-specific antibody within the first posttransplant week after desensitization for a +XM. Five patients underwent immediate splenectomy followed by PP/IVIg and had return of allograft function within 48 h of the procedure. Emergent splenectomy followed by PP/IVIg may be an effective treatment for reversing severe AMR.
  • Authors

    Published In

    Keywords

  • Adult, Female, Graft Rejection, Humans, Immunosuppressive Agents, Isoantibodies, Kidney Transplantation, Male, Middle Aged, Postoperative Complications, Splenectomy
  • Digital Object Identifier (doi)

    Author List

  • Locke JE; Zachary AA; Haas M; Melancon JK; Warren DS; Simpkins CE; Segev DL; Montgomery RA
  • Start Page

  • 842
  • End Page

  • 846
  • Volume

  • 7
  • Issue

  • 4