Prompt reversal of a severe complement activation by eculizumab in a patient undergoing intentional ABO‐incompatible pancreas and kidney transplantation |
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| Authors: | Ali‐Reza Biglarnia Bo Nilsson Thomas Nilsson Bengt von Zur‐Mühlen Michael Wagner Christian Berne Alkwin Wanders Anders Magnusson Gunnar Tufveson |
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| Affiliation: | 1. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;2. Division for Clinical Immunology, Uppsala University, Uppsala, Sweden;3. Department of Medical Sciences, Uppsala University, Uppsala, Sweden;4. Department of Pathology, Uppsala University, Uppsala, Sweden;5. Department of Radiology, Uppsala University, Uppsala, Sweden |
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| Abstract: | 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. |
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| Keywords: | ABO‐incompatible pancreas and kidney transplantation accommodation complement activation Eculizumab |
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