The use of eculizumab as a bridge to retransplantation for chronic antibody-mediated rejection in a heart transplant recipient: a case report.

Kearney, K; Macdonald, P; Hayward, C; Muthiah, K

The use of eculizumab as a bridge to retransplantation for chronic antibody-mediated rejection in a heart transplant recipient: a case report.

Kearney, K Macdonald, P

Hayward, C Muthiah, K

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Publisher:: Oxford University Press (OUP)
Publication Type:: Journal Article
Citation:: European heart journal. Case reports, 2021, 5, (5), pp. ytab180
Issue Date:: 2021-05-11

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Field	Value	Language
dc.contributor.author	Kearney, K
dc.contributor.author	Macdonald, P https://orcid.org/0000-0001-5378-2825
dc.contributor.author	Hayward, C
dc.contributor.author	Muthiah, K
dc.date.accessioned	2021-11-16T02:44:48Z
dc.date.available	2021-04-21
dc.date.available	2021-11-16T02:44:48Z
dc.date.issued	2021-05-11
dc.identifier.citation	European heart journal. Case reports, 2021, 5, (5), pp. ytab180
dc.identifier.issn	2514-2119
dc.identifier.issn	2514-2119
dc.identifier.uri	http://hdl.handle.net/10453/151605
dc.description.abstract	<h4>Background</h4>Antibody-mediated rejection (AMR) remains a major management challenge in heart transplantation given the complexity of pathological diagnosis and dearth of evidence for effective management. Eculizumab, an anti-C5 monoclonal antibody which inhibits terminal complement activation, has been reported to decrease early AMR in sensitized renal transplant recipients.<h4>Case summary</h4>We report a case of a 29-year-old gentleman with chronic AMR 8 years after heart transplantation, manifesting as significant graft dysfunction. Donor-specific antibodies to DQ7 were found to be causative. Antibody-mediated rejection was managed with quadruple oral immunosuppressive therapy (mycophenolate, prednisolone, everolimus, and tacrolimus) as well as a sequence of broad-spectrum immunological therapies; intravenous (IV) methylprednisolone, plasmapheresis, IV immunoglobulin, rituximab, bortezomib, tocilizumab, and splenic irradiation. No treatment had a sustained impact on donor-specific anti-HLA antibodies (DSAs) or graft function. After testing showed the DQ7 antibodies were complement-binding, a trial of eculizumab was started. This improved DSAs somewhat, and improved graft function and New York Heart Association functional class substantially. The patient was relisted for heart transplantation and successfully retransplanted in March 2018. Specifically, the new organ and recipient were matched at DQ7. After discontinuation of eculizumab, the patient has remained healthy and well, with normal graft function 28 months after retransplantation.<h4>Discussion</h4>To the best of our knowledge, this is the first case of chronic AMR in a heart transplant patient, successfully stabilized with eculizumab and bridged to retransplantation.
dc.format	Electronic-eCollection
dc.language	eng
dc.publisher	Oxford University Press (OUP)
dc.relation.ispartof	European heart journal. Case reports
dc.relation.isbasedon	10.1093/ehjcr/ytab180
dc.rights	info:eu-repo/semantics/openAccess
dc.title	The use of eculizumab as a bridge to retransplantation for chronic antibody-mediated rejection in a heart transplant recipient: a case report.
dc.type	Journal Article
utslib.citation.volume	5
utslib.location.activity	England
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
dc.date.updated	2021-11-16T02:44:47Z
pubs.issue	5
pubs.publication-status	Published
pubs.volume	5
utslib.citation.issue	5

Abstract:

Background

Antibody-mediated rejection (AMR) remains a major management challenge in heart transplantation given the complexity of pathological diagnosis and dearth of evidence for effective management. Eculizumab, an anti-C5 monoclonal antibody which inhibits terminal complement activation, has been reported to decrease early AMR in sensitized renal transplant recipients.

Case summary

We report a case of a 29-year-old gentleman with chronic AMR 8 years after heart transplantation, manifesting as significant graft dysfunction. Donor-specific antibodies to DQ7 were found to be causative. Antibody-mediated rejection was managed with quadruple oral immunosuppressive therapy (mycophenolate, prednisolone, everolimus, and tacrolimus) as well as a sequence of broad-spectrum immunological therapies; intravenous (IV) methylprednisolone, plasmapheresis, IV immunoglobulin, rituximab, bortezomib, tocilizumab, and splenic irradiation. No treatment had a sustained impact on donor-specific anti-HLA antibodies (DSAs) or graft function. After testing showed the DQ7 antibodies were complement-binding, a trial of eculizumab was started. This improved DSAs somewhat, and improved graft function and New York Heart Association functional class substantially. The patient was relisted for heart transplantation and successfully retransplanted in March 2018. Specifically, the new organ and recipient were matched at DQ7. After discontinuation of eculizumab, the patient has remained healthy and well, with normal graft function 28 months after retransplantation.

Discussion

To the best of our knowledge, this is the first case of chronic AMR in a heart transplant patient, successfully stabilized with eculizumab and bridged to retransplantation.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/151605