Antibody-mediated rejection with detection of de novo donor-specific anti-human leucocyte antigen Class II antibodies 3 years after heart transplantation: a case report

European Heart Journal. Case Reports
Bernd LudwigQian Zhou

Abstract

Antibody-mediated rejection (AMR) in cardiac transplantation may manifest early within the first weeks after transplantation but also late after months to years following transplantation resulting in mild heart failure to cardiogenic shock. While patients with early cardiac AMR are less affected and seem to have survival rates comparable to transplant recipients without AMR, late cardiac AMR is frequently associated with graft dysfunction, fulminant forms of cardiac allograft vasculopathy, and a high mortality rate. Nevertheless, AMR of cardiac allografts remains difficult to diagnose and to treat. We report the case of a 47-year-old male patient with late AMR of the cardiac allograft 3 years after heart transplantation. Antibody-mediated rejection was confirmed by endomyocardial biopsy and the presence of donor-specific antibodies (DSA). The patient was treated with high dose of prednisolone, plasmapheresis, intravenous Gamma Globulin, rituximab, immunoadsorption, and bortezomib. Under this treatment regimen left ventricular ejection fraction and pro B-type natriuretic peptide recovered, and the patient improved to New York Heart Association Class I. Currently, 3 years after the diagnosis of cardiac AMR, graft function continu...Continue Reading

References

Sep 7, 2005·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·H Edward GarrettKenneth Groshart
Aug 8, 2008·Current Opinion in Organ Transplantation·Raymond J Lynch, Jeffrey L Platt
Apr 4, 2015·Circulation·Monica M ColvinUNKNOWN American Heart Association Heart Failure and Transplantation Committee of the Council on Cardiovascular Surgery and Anesthes
May 10, 2015·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Guillaume CoutanceShaida Varnous
Jul 18, 2016·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Kevin J ClerkinDonna M Mancini

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BETA
biopsy

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