Four‐year allograft survival in a highly sensitized combined liver–kidney transplant patient despite unsuccessful anti‐HLA antibody reduction with rituximab,splenectomy, and bortezomib |
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| Authors: | Martina Koch Christian Gräser Anja Lehnhardt Jörg M. Pollok Nikolaus Kröger Murielle Verboom Friedrich Thaiss Thomas Eiermann Björn Nashan |
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| Affiliation: | 1. Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg‐Eppendorf (UKE), , Hamburg, Germany;2. Bone Marrow Transplantation Unit UKE, , Hamburg, Germany;3. Institute for Transfusion Medicine, Hannover Medical School, , Hannover, Germany;4. Department of Nephrology, Internal Medicine III UKE, , Hamburg, Germany;5. Department for Transfusion Medicine, HLA Laboratory UKE, , Hamburg, Germany |
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| Abstract: | Although donor‐specific lymphocytotoxic antibodies are regarded as a contraindication for kidney transplantation (KTx), the data available for liver or combined liver or kidney transplantation (cLKTx) are scarce. Here, we report a case of a highly sensitized young man receiving his sixth liver and second kidney graft. Multiple anti‐HLA antibodies were present at the time of transplantation. As a result of suspected antibody‐mediated graft damage, the patient was treated with rituximab, plasmapheresis, intravenous immunoglobulins, splenectomy, and bortezomib to decrease the antibody production. So far, patient and allograft survival has reached 4 years despite failure to achieve a permanent reduction of anti‐HLA antibodies, and particularly nondonor directed antibodies. |
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| Keywords: | anti‐HLA antibodies bortezomib combined liver– kidney transplantation rituximab splenectomy |
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