Zaltzman-Girshevich S, Espinosa F, Béjar Y, Leo C, Manzano-Jiménez A, Calderón-Mendieta F

Language: Spanish
References: 13
Page: 61-68
PDF size: 244.32 Kb.

ABSTRACT

The presence of preformed antibodies has been the cause of many failures in organ transplantation; because of this we describe a successful transplantation in a 17 year-old female adolescent, who rejected the kidney from her mother the first two weeks after surgery: she developed antibodies against some of the HLA antigens from her mother’s kidney. These antibodies also acted against some of the antigens present in the father’s kidney and were probably the cause of the first rejection. This situation was noticed when an Antibody Reactive Panel was performed. These antigens were present in the Class I and Class II HLA complex. After the rejection she was kept in hemodialysis, and thereafter we instituted a therapeutic protocol to prevent rejection in the presence of preformed antibodies based on inhibition of the formation of humoral antibodies, modification of cellular immunity, as well blocking the site of action of the remaining antibodies. In order to achieve this we use monoclonal antibodies ANTI CD20, pretransplant plasmapheresis, intravenous immunoglobulin, monoclonal antibodies ANTI CD25, plus steroid, i.e., mofetil mycophenolate and tacrolimus. The course was successful despite multiple surgical complications, and infections (mainly CMV). One year after the procedure, she has been followed as an outpatient. Her renal function is excellent.

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