Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation

Acute humoral rejection （AHR） is uncommon after ABO- compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experie...

Full description

Saved in:
Bibliographic Details
Published in:World journal of gastroenterology : WJG 2009-07, Vol.15 (27), p.3426-3430
Main Authors: Kamar, Nassim, Lavayssière, Laurence, Muscari, Fabrice, Selves, Janick, Guilbeau-Frugier, Céline, Cardeau, Isabelle, Esposito, Laure, Cointault, Olivier, Nogier, Marie Béatrice, Peron, Jean Marie, Otal, Philippe, Fort, Marylise, Rostaing, Lionel
Format: Article
Language:English
Subjects:
ABO Blood-Group System - immunology
ABO血型
Adult
Antibodies, Monoclonal - therapeutic use
Antibodies, Monoclonal, Murine-Derived
Blood Group Incompatibility - immunology
Blood Group Incompatibility - therapy
Case Report
Female
Graft Rejection - immunology
Graft Rejection - pathology
Graft Rejection - therapy
Humans
Immunologic Factors - therapeutic use
Liver Transplantation - adverse effects
Middle Aged
Plasmapheresis
Rituximab
Treatment Outcome
肝移植
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Acute humoral rejection （AHR） is uncommon after ABO- compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Uver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab. Liver enzymes returned to within normal range 18 d after diagnosis. Uver biopsies, at 3 and 9 mo post-transplant, showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.15.3426