Mixed acute cellular and humoral rejection is diagnosed uncommonly among heart transplant recipients and usually occurs within the first post-transplant month. We report a case of fatal, fulminant, mixed, acute cellular and humoral rejection in a 33-year-old woman 6 weeks after orthotopic heart transplantation. She had been treated with intravenous methylprednisolone for International Society for Heart and Lung Transplantation (ISHLT) Grade 2 rejection at post-operative Day 28. Despite intensification of immunosuppression therapy, she developed fever and progressive hemodynamic instability. Autopsy results revealed ISHLT Grade 4 mixed cellular and humoral rejection. Cellular rejection is a well-described mechanism of graft failure early after heart transplantation. Although humoral rejection also is recognized as contributing to early graft failure, its characteristics and clinical implications are not as well characterized. We describe a patient with fulminant mixed rejection, despite intensified immunosuppression therapy, early after orthotopic heart transplantation who presented with high-grade fever. We include a review of the literature on humoral and mixed rejections.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/s1053-2498(02)00659-9 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Effectiveness of complement inhibitors against refractory antibody-mediated rejection of lung transplantation: Two clinical cases.
Transpl Immunol
January 2025
Univ. Grenoble Alpes, CNRS, Pharmacy Department, TIMC, UMR5525, Grenoble Alpes University, Grenoble, France.
Antibody-mediated rejection (AMR) has been recognized as a significant cause of acute and chronic lung allograft dysfunction after lung transplantation. Some treatments, eculizumab, an anti-complement (C)5 component monoclonal antibody (Mab), seem to have a promising effect in the management of some patients with AMR. We present two patients with acute AMR after lung transplantation who received the anti-C5 Mab therapy.
View Article and Find Full Text PDFCD154 blockade effectively controls antibody-mediated rejection in highly sensitized nonhuman primate kidney transplant recipients.
Sci Transl Med
January 2025
Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Article Synopsis
- Current kidney transplant regimens often struggle to prevent antibody-mediated rejection (ABMR) in sensitized individuals, leading to graft failure.
- Research showed that anti-CD154 monoclonal antibody (mAb) treatment for kidney transplants in nonhuman primates was more effective at controlling rejection and post-transplant immune responses than standard tacrolimus-based therapy.
- The anti-CD154-treated group had significantly longer survival rates, better suppression of harmful antibodies, and fewer complications post-transplant, suggesting that anti-CD154 mAbs could enhance outcomes in sensitized kidney transplant patients.
Rejection in the setting of combined Heart and Liver Transplantation.
Int J Cardiol Congenit Heart Dis
March 2024
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Introduction: Each year the number of combined heart-liver transplants (HLT) increases, with two distinct patient populations proceeding down this pathway. The first are patients with congenital heart disease (CHD), most commonly single ventricle patients palliated with Fontan. The second group are those with long standing congestive hepatopathy, amyloidosis, hemochromatosis, or alcohol induced myopathies and liver disease.
View Article and Find Full Text PDFLong-term allograft survival is limited by humoral-associated chronic allograft rejection, suggesting inadequate constraint of humoral alloimmunity by contemporary immunosuppression. Heterogeneity in alloreactive B cells and the incomplete definition of which B cells participate in chronic rejection in immunosuppressed transplant recipients limits our ability to develop effective therapies. Using a double-fluorochrome single-HLA tetramer approach combined with single-cell culture, we investigated the B-cell receptor (BCR) repertoire characteristics, avidity, and phenotype of donor HLA-DQ reactive B cells in a transplant recipient with end-stage donor specific antibody (DSA)-associated cardiac allograft vasculopathy while receiving maintenance immunosuppression (tacrolimus, mycophenolate mofetil, prednisone).
View Article and Find Full Text PDFBiopsy-Proven T-Cell Mediated Rejection After Belatacept Rescue Conversion: A Multicenter Retrospective Study.
Transpl Int
December 2024
Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.
After kidney transplantation, conversion to belatacept is a promising alternative in patients with poor graft function or intolerance to calcineurin inhibitors. The risk of acute rejection has not been well described under these conditions. Here we present a retrospective multicenter study investigating the occurrence of acute rejection after conversion in 901 patients (2011-2021).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!