Use of Eculizumab in Pediatric Patients with Late Antibody-Mediated Rejection After Kidney Transplantation

• Published in: Experimental and clinical transplantation Vol. 20; no. Suppl 3; pp. 49 - 52
• Main Authors: Siddiqui, Meraj Alam, Baskin, Esra, Yarbug Karakayali, Feza, Gemici, Atilla, Gulleroglu, Kaan, Caltik Yilmaz, Aysun, Moray, Gokhan, Haberal, Mehmet
• Format: Journal Article
• Language: English
• Published: Turkey 01.05.2022
• Subjects: Adolescent; Antibodies, Monoclonal, Humanized - therapeutic use; Child; Creatinine; Graft Rejection - drug therapy; Graft Rejection - prevention & control; Humans; Immunosuppressive Agents - adverse effects; Kidney Failure, Chronic - etiology; Kidney Transplantation - adverse effects; Male; Treatment Outcome
• ISSN: 1304-0855; 2146-8427
• DOI: 10.6002/ect.PediatricSymp2022.O15

Late antibody-mediated rejection triggered by donor-specific antibodies is a leading cause of kidney allograft failure. Effective treatment options for late antibody-mediated rejection are limited in renal transplant recipients. Here, we report 2 pediatric cases of severe late antibody-mediated rejection resistant to conventional immunosuppressive therapy who were successfully treated with eculizumab. Two patients who fulfilled the late antibody-mediated rejection diagnostic criteria (positive donor-specific antibodies, elevated mean fluorescence index, acute and/or chronic morphological lesions in the microvasculature, and abnormal kidney function test) were included in this study. Both patients were previously unsensitized with negative panel-reactive antibody. Case 1 was a 12-year-old male patient with kidney failure secondary to vesicoureteral reflux who underwent related-living donor kidney transplantation 2 years ago. Eleven months later, he was diagnosed with late antibody-mediated rejection. Despite an aggressive conventional immunosuppressive regimen, signs of rejection persisted. After the patient was treated with 2 doses of eculizumab, his mean fluorescence index dropped and serum creatinine decreased from 3.8 to 1.5 mg/dL. Case 2 was an unsensitized 16-year-old male patient with kidney failure secondary posterior urethral valve who underwent related-living donor kidney transplantation 4 years ago. Two years later, he was diagnosed with late antibody-mediated rejection. Despite an aggressive conventional immunosuppressive regimen, signs of rejection persisted. After treatment with 2 doses of eculizumab, his mean fluorescence index dropped and serum creatinine decreased from 2.1 to 1.01 mg/dL. In both patients, eculizumab therapy effectively reduced the markers of late antibody-mediated rejection and improved the kidney function.