Successful treatment of early acute antibody-mediated rejection in an human leukocyte antigen-incompatible and ABO-incompatible living-donor kidney transplant patient

Abstract

For successful human leukocyte antigen-incompatible (HLAi) or ABO-incompatible (ABOi) living-donor kidney transplantations (LDKTs), pretransplant desensitization is essential; however, early antibody-mediated rejection (ABMR) remains the most important complication after HLAi or ABOi transplantation. Here, we report a case of early acute ABMR in simultaneous HLAi and ABOi LDKT with preformed donor-specific antibody (DSA), despite desensitization. Dialysis-dependent, severe ABMR occurred with a rebound of pre-existing DSA and appearance of de novo DSA after initial normalization of renal function, 8 days postoperatively. However, a low anti-ABO antibody titer (1:8) was maintained after transplantation. Combination therapy of plasmapheresis, high-dose intravenous immunoglobulin, and bortezomib improved both ABMR and renal functions. Thus, an appropriate preventive and therapeutic management for early ABMR is important among high-risk LDKT patients. Furthermore, early AMBR can occur despite pretransplant desensitization as seen in this case, and close monitoring of the patient and prompt management are considered vital for better therapeutic outcomes.

Clinical significance of de novo donor-specific antibody in kidney transplant recipients with chronic antibody-mediated rejection

“…The most common treatment options for CABMR patients are rituximab and IVIG, but their effectiveness is still controversial [ 8 - 10 ]. Some studies have shown that bortezomib is effective for antibody-mediated rejection [ 11 ]. For the treatment of CABMR, we used the same protocol, irrespective of the presence of dnDSA or C4d, unlike in previous studies, which treated the dnDSA (–) group less aggressively than the dnDSA (+) group [ 12 ].…”