Serum sickness following rabbit antithymocyte-globulin induction in a liver transplant recipient: Case report and literature review

被引：38

作者：

Lundquist, Andrew L.

Chari, Ravi S.

Wood, James H.

Miller, Geraldine G.

Schaefer, Heidi M.

Raiford, David S.

Wright, Kelly J.

Gorden, D. Lee

机构：

[1] Vanderbilt Univ, Med Ctr, Dept Surg, Div Hepatobiliary Surg & Liver Transplantat, Nashville, TN 37232 USA

[2] Vanderbilt Univ, Med Ctr, Dept Canc Biol, Nashville, TN USA

[3] Vanderbilt Univ, Med Ctr, Dept Med, Div Infect Dis, Nashville, TN USA

[4] Vanderbilt Univ, Med Ctr, Dept Med, Div Nephrol, Nashville, TN USA

[5] Vanderbilt Univ, Med Ctr, Dept Med, Div Gastroenterol & Hepatol, Nashville, TN USA

来源：

LIVER TRANSPLANTATION | 2007年 / 13卷 / 05期

关键词：

D O I：

10.1002/lt.21098

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Thymoglobulin (R) (Genzyme, Cambridge, MA) is an antithymocyte globulin preparation used for induction immunosuppression therapy in solid organ transplantation. It is being utilized with increasing frequency in orthotopic liver transplantation (OLT) in an effort to minimize or delay the use of calcineurin inhibitors due to their inherent nephrotoxicity. Experience with thymoglobulin in OLT remains limited. We report a case of serum sickness in a patient who received thymoglobulin following OLT. The patient experienced intermittent fevers, polyarthralgia, and acute renal failure 9 days after completion of thymoglobulin administration. The patient's symptoms resolved rapidly and completely with a course of intravenous steroids. We review a set of diagnostic criteria for serum sickness and emphasize the importance of early recognition of the process. Early treatment of serum sickness with steroids or plasmapheresis is highly effective and can reduce unnecessary morbidity from this unusual sequela of induction immunosuppression with antithymocyte globulin.

引用

页码：647 / 650

页数：4

共 22 条

[1] Short-term outcomes of Thymoglobulin induction in pediatric renal transplant recipients [J].

Ault, BH ;

Honaker, MR ;

Gaber, AO ;

Jones, DP ;

Duhart, BT ;

Powell, SL ;

Hays, DW ;

Wyatt, RJ .

PEDIATRIC NEPHROLOGY, 2002, 17 (10) :815-818

[2] HUMAN-SERUM SICKNESS - A PROSPECTIVE ANALYSIS OF 35 PATIENTS TREATED WITH EQUINE ANTI-THYMOCYTE GLOBULIN FOR BONE-MARROW FAILURE [J].

BIELORY, L ;

GASCON, P ;

LAWLEY, TJ ;

YOUNG, NS ;

FRANK, MM .

MEDICINE, 1988, 67 (01) :40-57

[3] Thymoglobulin induction protects liver allografts from ischemia/reperfusion injury [J].

Bogetti, D ;

Sankary, HN ;

Jarzembowski, TM ;

Manzelli, A ;

Knight, PS ;

Thielke, J ;

Chejfec, G ;

Cotler, S ;

Oberholzer, J ;

Testa, G ;

Benedetti, E .

CLINICAL TRANSPLANTATION, 2005, 19 (04) :507-511

[4] COMPARATIVE POLYCLONAL ANTITHYMOCYTE GLOBULIN AND ANTILYMPHOCYTE ANTILYMPHOBLAST GLOBULIN ANTI-CD ANTIGEN-ANALYSIS BY FLOW-CYTOMETRY [J].

BOURDAGE, JS ;

HAMLIN, DM .

TRANSPLANTATION, 1995, 59 (08) :1194-1200

[5] Induction therapy by anti-thymocyte globulin (rabbit) in renal transplantation:: a 1-yr follow-up of safety and efficacy [J].

Büchler, M ;

de Ligny, BH ;

Madec, C ;

Lebranchu, Y .

CLINICAL TRANSPLANTATION, 2003, 17 (06) :539-545

[6] A three-arm study comparing immediate tacrolimus therapy with antithymocyte globulin induction therapy followed by tacrolimus or cyclosporine A in adult renal transplant recipients [J].

Charpentier, B ;

Rostaing, L ;

Berthoux, F ;

Lang, P ;

Civati, G ;

Touraine, JL ;

Squifflet, JP ;

Vialtel, P ;

Abramowicz, D ;

Mourad, G ;

Wolf, P ;

Cassuto, E ;

Moulin, B ;

Rifle, G ;

Pruna, A ;

Merville, P ;

Mignon, F ;

Legendre, C ;

Le Pogamp, P ;

Lebranchu, Y ;

Toupance, O ;

de Ligny, BH ;

Touchard, G ;

Olmer, M ;

Purgus, R ;

Pouteil-Noble, C ;

Glotz, D ;

Bourbigot, B ;

Leski, M ;

Wauters, JP ;

Kessler, M .

TRANSPLANTATION, 2003, 75 (06) :844-851

[7] Plasmapheresis and RATG-induced serum sickness [J].

Christiaans, MHL ;

van Hooff, JP .

TRANSPLANTATION, 2006, 81 (02) :296-296

[8] Rabbit antithymocyte globulin as induction immunotherapy in pediatric heart transplantation [J].

Di Filippo, S ;

Boissonnat, P ;

Sassolas, F ;

Robin, J ;

Ninet, J ;

Champsaur, G ;

Bozio, A .

TRANSPLANTATION, 2003, 75 (03) :354-358

[9] Steroid-free liver transplantation using rabbit antithymocyte globulin induction: Results of a prospective randomized trial [J].

Eason, JD ;

Loss, GE ;

Blazek, J ;

Nair, S ;

Mason, AL .

LIVER TRANSPLANTATION, 2001, 7 (08) :693-697

[10] Immunosuppression in liver transplantation beyond calcineurin inhibitors [J].

Fung, J ;

Kelly, D ;

Kadry, Z ;

Patel-Tom, K ;

Eghtesad, B .

LIVER TRANSPLANTATION, 2005, 11 (03) :267-280

← 1 2 3 →