Refractory Acute Antibody Mediated Rejection in Liver Transplant After Desensitization of Preformed Donor Specific Antibody-Validity of Bortezomib and Everolimus: A Case Report.

Autor: Komagome M; Hepato-Pancreato-Biliary Surgery, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan., Maki A; Hepato-Pancreato-Biliary Surgery, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan. Electronic address: amaki@saitama-med.ac.jp., Nagata R; Department of Pathology, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan., Masuda W; Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan., Kogure R; Hepato-Pancreato-Biliary Surgery, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan., Mitsui T; Hepato-Pancreato-Biliary Surgery, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan., Ninomiya R; Hepato-Pancreato-Biliary Surgery, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan., Akamatsu N; Department of Pathology, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan., Hasegawa K; Department of Pathology, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan., Beck Y; Hepato-Pancreato-Biliary Surgery, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2022 Jan-Feb; Vol. 54 (1), pp. 147-152. Date of Electronic Publication: 2021 Dec 30.
DOI: 10.1016/j.transproceed.2021.11.022
Abstrakt: Here, we report a case of living donor liver transplantation (LDLT) complicated with severe acute antibody-mediated rejection (aAMR), although desensitization was performed for preformed donor-specific anti-human leukocyte antigen antibody (DSA). LDLT was performed in a 59-year-old woman with alcoholic cirrhosis with a graft from her 60-year-old husband as a living donor. She had reproductive history of 4 gravidity and parity with her husband. Preoperative serologic studies showed positive complement-dependent cytotoxic crossmatch and anti-human leukocyte antigen-A26 antibody was identified as DSA. Desensitization for preformed DSA with rituximab and plasma exchange was performed before LDLT. We decided to perform LDLT using her husband right liver as living donor graft since the DSA mean fluoro-intensity was down to negative range. The immunosuppressive regimen was comprised with steroid and tacrolimus. However, the recipient developed acute cellular rejection on day 5 after LDLT, followed by severe aAMR. Re-administration of rituximab followed by 4 courses of plasma exchange failed to treat aAMR. The DSA mean fluoro-intensity was successfully suppressed after bortezomib was administered however impaired serologic liver function test and cholestasis were remained. The liver function test and cholestasis in the graft were improved after Everolimus was administered. The recipient was discharged on postoperative day 196. In conclusion, we report a case of LDLT who developed aAMR after desensitization of preformed DSA and was successfully treated with intensive therapy with bortezomib and everolimus.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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