Akademik Veri Yönetim Sistemi
17th BANTAO Congress, Antalya, Türkiye, 10 - 13 Kasım 2022, ss.23
Objective: In kidney transplantation, highly sensitized patients due to donor-specific antibodies (DSA) or ESRD etiology such as aHUS that will cause high post-transplant recurrence and allograft loss are at high risk for early allograft loss. In this case report, a patient who had both of the mentioned risks and the approach for a successful kidney transplant is described.
Case: A 27-year-old woman had a one and a half year history of using eculizumab due to aHUS diagnosed during pregnancy. She applied for preemptive kidney transplantation from a living donor partner. Pretransplant immunologic tests revealed, Complement dependent cytotoxicity (CDC) B cell cross border negative, Flow Crossmatch B-cell positive and DSA against 3/6 HLA antigen was detected in Single Ag test of the patient ( HLA-A*01 3867 MFI, HLA-B* 37 vs. 1716 MFI, HLA-DRB1*10 vs. 4192 MFI). Rituximab 375 mg/m2 was added to the protocol 14 days before kidney transplantation due to DSA. Also transplantation was planned with eculizumab prophylaxis, preoperative eculizumab 900 mg was administered the day before the operation and kidney transplantation was performed. The patient, whose allograft functioned very well in the follow-up, was discharged one week later with an additional dose of prophylactic 900 mg eculizumab and basal creatinine of 0.9mg/dl. Routinely, 900 mg eculizumab every 15 days was recommended. Allograft functions remained stable in the outpatient clinic controls (last creatinine 0.85mg/dl). After three months DSAs were controlled, single Ag Class 1 and 2 tests were negative.
Conclusion: With the terminal complement inhibition provided by eculizumab, two-way benefit was achieved in both aHUS and acute antibody-mediated rejection prophylaxis. On the other hand, rituximab successfully suppressed DSA production in the long term. Combined use of current monoclonal antibodies may increase kidney transplant success and allograft survival in selected cases with multiple risks, as in the case presented here.