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Case Report

Korean J Transplant 2019; 33(4): 153-158

Published online December 31, 2019

https://doi.org/10.4285/jkstn.2019.33.4.153

© The Korean Society for Transplantation

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

Sujin Gang1, Ahram Han1,2, Sang-il Min1,2, Jongwon Ha1,2, Jaeseok Yang1,2,3

Departments of 1Surgery and 2Transplantation Center, Seoul National University Hospital, Seoul, Korea; 3Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: Jaeseok Yang
Department of Surgery, Transplantation center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-4128, Fax: +82-2-2072-4129 E-mail: jcyjs@snu.ac.kr

Received: November 12, 2019; Revised: December 17, 2019; Accepted: December 19, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Desensitization, Human leukocyte antigen, Kidney transplantation, Living donor, Rejection