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

59 Citations (Scopus)

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 2007
Externally publishedYes

Fingerprint

Splenectomy
Antibodies
Plasmapheresis
Intravenous Immunoglobulins
Therapeutics
Kidney
Living Donors
Causality
Creatinine
Adrenal Cortex Hormones
Transplantation
Transplants
Serum

Keywords

  • Kidney transplant
  • Refractory antibody-mediated rejection
  • Splenectomy

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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

Successful rescue of refractory, severe antibody mediated rejection with splenectomy. / Kaplan, Bruce; Gangemi, Antonio; Thielke, James; Oberholzer, José; Sankary, Howard; Benedetti, Enrico.

In: Transplantation, Vol. 83, No. 1, 01.2007, p. 99-100.

Research output: Contribution to journalArticle

Kaplan, B, Gangemi, A, Thielke, J, Oberholzer, J, Sankary, H & Benedetti, E 2007, 'Successful rescue of refractory, severe antibody mediated rejection with splenectomy', Transplantation, vol. 83, no. 1, pp. 99-100. https://doi.org/10.1097/01.tp.0000243739.31440.2b
Kaplan, Bruce ; Gangemi, Antonio ; Thielke, James ; Oberholzer, José ; Sankary, Howard ; Benedetti, Enrico. / Successful rescue of refractory, severe antibody mediated rejection with splenectomy. In: Transplantation. 2007 ; Vol. 83, No. 1. pp. 99-100.
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