Successful rescue of refractory, severe antibody mediated rejection with splenectomy

Bruce Kaplan, Antonio Gangemi, James Thielke, José Oberholzer, Howard Sankary, Enrico Benedetti

    Research output: Contribution to journalArticle

    62 Scopus citations

    Abstract

    Antibody-mediated rejection (AMR) commonly occurs after transplantation of ABO-incompatible and sensitized renal transplant. Treatment regimens commonly include a combination of plasmapheresis (PL) and intravenous immunoglobulin (IVIG). However, some cases of AMR remain refractory to treatment. We report a case series of four patients with AMR refractory to standard therapy (ST) who resolved after splenectomy. Four living donor kidney transplant recipients were diagnosed with AMR. Two patients were ABO incompatible, one was cross-match positive and one had no obvious predisposing factors. After failure of therapy with corticosteroids, PL, IVIG, Thymoglobulin, and Rituximab (three patients) or Campath (one patient), AMR was treated with laparoscopic splenectomy. After an average of 11 days of ST, laparoscopic splenectomy was performed for rescue. The urinary output improved immediately in all patients, serum creatinine levels decreased within 48 hr, and ABO titers fell in the ABO-incompatible patient and the cross-match became negative in the two sensitized patients. Splenectomy may play a role in the treatment of AMR refractory to ST.

    Original languageEnglish (US)
    Pages (from-to)99-100
    Number of pages2
    JournalTransplantation
    Volume83
    Issue number1
    DOIs
    StatePublished - Jan 1 2007

    Keywords

    • Kidney transplant
    • Refractory antibody-mediated rejection
    • Splenectomy

    ASJC Scopus subject areas

    • Transplantation

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  • Cite this

    Kaplan, B., Gangemi, A., Thielke, J., Oberholzer, J., Sankary, H., & Benedetti, E. (2007). Successful rescue of refractory, severe antibody mediated rejection with splenectomy. Transplantation, 83(1), 99-100. https://doi.org/10.1097/01.tp.0000243739.31440.2b