Prompt reversal of a severe complement activation by eculizumab in a patient undergoing intentional ABO‐incompatible pancreas and kidney transplantation

• Published in: Transplant international Vol. 24; no. 8; pp. e61 - e66
• Main Authors: Biglarnia, Ali‐Reza, Nilsson, Bo, Nilsson, Thomas, von Zur‐Mühlen, Bengt, Wagner, Michael, Berne, Christian, Wanders, Alkwin, Magnusson, Anders, Tufveson, Gunnar
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2011; Frontiers Media SA
• Subjects: ABO Blood-Group System - immunology; ABO-incompatible pancreas and kidney transplantation; accommodation; Adult; Antibodies; Antibodies, Monoclonal, Humanized - pharmacology; Blood Group Incompatibility - immunology; Complement Activation; Complement System Proteins; Diabetes Mellitus - therapy; Eculizumab; Enzyme-Linked Immunosorbent Assay - methods; Humanized/pharmacology; Humans; Immunophenotyping - methods; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - methods; Male; MEDICIN; MEDICINE; Monoclonal; Pancreas; Pancreas Transplantation - methods; Pathology; Patologi; Renal Insufficiency - complications; Renal Insufficiency - therapy; Renal Insufficiency/complications/therapy; Transplants & implants
• ISSN: 0934-0874; 1432-2277; 1432-2277
• DOI: 10.1111/j.1432-2277.2011.01290.x

Summary We describe the presumably first intentional ABO‐incompatible deceased‐donor kidney and pancreas transplantation with a severe antibody‐mediated rejection during a rebound of isoagglutinins. Rejection was successfully treated with eculizumab, which inhibits the terminal pathway of complement. Complement analysis (C3, C3d,g, and a modified assay of classical complement‐related hemolytic function) documented complement activation and confirmed that eculizumab completely blocked complement function. At 6 months, the patient had normal kidney and pancreas function, and histological evaluations revealed no evidence of sustained graft damage. This successful transplantation suggests that ABO barriers can safely be overcome without extensive preconditioning, when the complement inhibitor eculizumab is included.