Prompt reversal of a severe complement activation by eculizumab in a patient undergoing intentional ABO-incompatible pancreas and kidney transplantation

• We describe the presumably first intentional ABO-incompatible deceased-donor kidney and pancreas transplantation with a severe antibody-mediated rejection during a rebound of isoagglutinins. Rejection was successfully treated with eculizumab, which inhibits the terminal pathway of complement. Complement analysis (C3, C3d,g, and a modified assay of classical complement-related hemolytic function) documented complement activation and confirmed that eculizumab completely blocked complement function. At 6 months, the patient had normal kidney and pancreas function, and histological evaluations revealed no evidence of sustained graft damage. This successful transplantation suggests that ABO barriers can safely be overcome without extensive preconditioning, when the complement inhibitor eculizumab is included.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine (hsv//eng)

Nyckelord

ABO Blood-Group System/*immunology

Adult

Antibodies

Monoclonal

Humanized/*pharmacology

Blood Group Incompatibility/*immunology

Complement Activation

Complement System Proteins

Diabetes Mellitus/therapy

Enzyme-Linked Immunosorbent Assay/methods

Humans

Immunophenotyping/methods

Immunosuppressive Agents/therapeutic use

Kidney Transplantation/*methods

Male

Pancreas Transplantation/*methods

Renal Insufficiency/complications/*therapy

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)