Treatment of antibody-mediated accelerated rejection using plasmapheresis

Accelerated antibody-mediated rejection is believed to be due to an anamnes tic response of an allograft recipient to donor antigens. Few reports have demonstrated successful reversal of this type of rejection, and no consensu s exists for either diagnosis or treatment. Accelerated antibody-mediated r ejection was suspected on the basis of clinical findings and confirmed by c ytotoxic and flow crossmatches, and leukocyte antibody screens. Serial cros smatches and antibody screens were performed through post-transplant day 11 2. Plasmapheresis was performed on posttransplant days 1, 2, 4, 6, 12, 14, 20, and 28. The duration of treatment was determined by the cytotoxic cross match results. We present a case of successfully treated accelerated antibo dy-mediated rejection using plasmapheresis and aggressive immunosuppression . Serial crossmatch and leukocyte antibody screen results are presented tha t confirm the production of anti-donor antibody and demonstrate the effecti veness of the treatment protocol in eliminating detectable levels of the an ti-donor antibody. At 6 months post-transplant, the patient has a serum cre atinine of 1.1 and has not had any additional rejection episodes or infecti ous complications. The protocol suggested in this paper allows for rapid di agnosis, institution of treatment, and monitoring the efficacy of treatment , providing the basis for follow-up clinical trials. J. Clin. Apheresis 15: 180-183, 2000. (C) 2000 Wiley-Liss,Inc.