Antibody‐mediated rejection after ABO‐incompatible pediatric living donor liver transplantation for propionic acidemia: A case report |
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Authors: | Masaki Honda Seisuke Sakamoto Rieko Sakamoto Shirou Matsumoto Tomoaki Irie Koushi Uchida Keita Shimata Seiichi Kawabata Kaori Isono Shintaro Hayashida Hidekazu Yamamoto Fumio Endo Yukihiro Inomata |
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Affiliation: | 1. Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan;2. Department of Pediatrics, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan;3. Department of Pediatric Surgery, Kumamoto City Hospital, Kumamoto, Japan |
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Abstract: | We herein present the case of a four‐yr‐old boy with PA who developed AMR after ABO‐incompatible LDLT despite undergoing B cell desensitization using rituximab. Although the CD19+ lymphocyte count decreased to 0.1% nine days after the administration of rituximab, he developed a high fever which was accompanied by arthralgia due to a streptococcal infection 13 days after rituximab prophylaxis. After the clearance of the infection, he underwent ABO‐incompatible LDLT 36 days after the administration of rituximab. The CD19+ lymphocyte count just prior to LDLT was 1.2%. He developed AMR five days after LDLT, and the antidonor‐type IgM and IgG antibody titers increased to 1:1024 and 1:1024, respectively. He was treated by plasma exchange, IVIG, steroid pulse therapy, and rituximab re‐administration; however, his liver dysfunction continued. Despite intensive treatment, he died due to complicated abdominal hernia, acute renal failure, and ARDS. This case suggests that a streptococcal infection may induce the activation of innate immune responses; thus, additional desensitization therapy should be considered prior to ABO‐incompatible LDLT if B cell reactivation is suspected. |
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Keywords: | antibody‐mediated rejection propionic acidemia rituximab streptococcal infection |
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