The utility of splenectomy as rescue treatment for severe acute antibody mediated rejection

被引:90
作者
Locke, J. E.
Zachary, A. A.
Haas, M.
Melancon, J. K.
Warren, D. S.
Simpkins, C. E.
Segev, D. L.
Montgomery, R. A. [1 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA
[3] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21205 USA
关键词
D O I
10.1111/j.1600-6143.2006.01709.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Antibody-mediated rejection (AMR) after desensitization for a positive crossmatch (+XM) live donor renal transplant can be severe and result in sudden onset oliguria and loss of the allograft. Attempts to rescue these kidneys using plasmapheresis (PP) and IVIg may be ineffective due to the magnitude of antibody burden that must be controlled to prevent renal thrombosis or cortical necrosis. We review our experience using splenectomy combined with PP/IVIg as rescue therapy for patients experiencing an acute deterioration in renal function and a rise in donor-specific antibody within the first posttransplant week after desensitization for a +XM. Five patients underwent immediate splenectomy followed by PP/IVIg and had return of allograft function within 48 h of the procedure. Emergent splenectomy followed by PP/IVIg may be an effective treatment for reversing severe AMR.
引用
收藏
页码:842 / 846
页数:5
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