Humoral rejection after pediatric heart transplantation: a case report. Prog Transplant 2010 Sep;20(3):288-91
Date
10/12/2010Pubmed ID
20929115DOI
10.1177/152692481002000314Scopus ID
2-s2.0-79952063346 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
Humoral rejection was observed 2 years after heart transplantation in a 10-year-old African American girl with sickle cell disease. Hemodynamic compromise developed, and the patient started treatment with extracorporeal membrane oxygenation within 24 hours of admission. With cellular rejection initially believed to be the cause, administration of thymoglobulin and high-dose steroids was initiated. Human leukocyte antigen antibody analysis revealed high titers of donor-specific class I and II antibodies. Aggressive treatment for antibody-mediated rejection was started with plasmapheresis and administration of intravenous immune globulin and rituximab. The patient displayed clinical signs of infection and was treated with antimicrobial, antiviral, and antifungal agents. Computed tomography of the chest suggested asperigillous infection. The patient underwent a left upper lobectomy. The patient recovered and has done well, now 4 years after having received the heart transplant. Antibody-mediated rejection should be considered early in heart transplant patients presenting with hemodynamic compromise and may respond to aggressive antibody and B cell-directed therapy. Vigilance for secondary infections, especially during treatment for rejection, is crucial.
Author List
Stendahl G, Berger S, Ellis T, Gandy K, Mitchell M, Tweddell J, Zangwill SAuthor
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Anemia, Sickle CellAntibodies, Monoclonal, Murine-Derived
Cardiomyopathy, Dilated
Child
Delayed Diagnosis
Extracorporeal Membrane Oxygenation
Female
Graft Rejection
Heart Transplantation
Humans
Immunity, Humoral
Immunoglobulins, Intravenous
Immunologic Factors
Plasmapheresis
Pneumonectomy
Rituximab
Tomography, X-Ray Computed
