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Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch

Preformed donor-specific antibodies are associated with a higher risk of rejection and worse graft survival in organ transplantation. However, in heart transplantation, the risk and benefit balance between high mortality on the waiting list and graft survival may allow the acceptance of higher immun...

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Autores principales: Yamamoto, Takayuki, Pearson, Daniel S., Ababneh, Emad I., Harris, Cynthia, Nissaisorakarn, Pitchaphon, Mahowald, Grace K., Heher, Yael K., Elias, Nahel, Markmann, James F., Lewis, Gregory D., Riella, Leonardo V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479575/
https://www.ncbi.nlm.nih.gov/pubmed/37675007
http://dx.doi.org/10.3389/fneph.2022.1047217
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author Yamamoto, Takayuki
Pearson, Daniel S.
Ababneh, Emad I.
Harris, Cynthia
Nissaisorakarn, Pitchaphon
Mahowald, Grace K.
Heher, Yael K.
Elias, Nahel
Markmann, James F.
Lewis, Gregory D.
Riella, Leonardo V.
author_facet Yamamoto, Takayuki
Pearson, Daniel S.
Ababneh, Emad I.
Harris, Cynthia
Nissaisorakarn, Pitchaphon
Mahowald, Grace K.
Heher, Yael K.
Elias, Nahel
Markmann, James F.
Lewis, Gregory D.
Riella, Leonardo V.
author_sort Yamamoto, Takayuki
collection PubMed
description Preformed donor-specific antibodies are associated with a higher risk of rejection and worse graft survival in organ transplantation. However, in heart transplantation, the risk and benefit balance between high mortality on the waiting list and graft survival may allow the acceptance of higher immunologic risk donors in broadly sensitized recipients. Transplanting donor-recipient pairs with a positive complement dependent cytotoxic (CDC) crossmatch carries the highest risk of hyperacute rejection and immediate graft loss and is usually avoided in kidney transplantation. Herein we report the first successful simultaneous heart-kidney transplant with a T- and B-cell CDC crossmatch positive donor using a combination of rituximab, intravenous immunoglobulin, plasmapheresis, bortezomib and rabbit anti-thymocyte globulin induction followed by eculizumab therapy for two months post-transplant. In the year following transplantation, both allografts maintained stable graft function (all echocardiographic left ventricular ejection fractions ≥ 65%, eGFR>60) and showed no histologic evidence of antibody-mediated rejection. In addition, the patient has not developed any severe infections including cytomegalovirus or BK virus infection. In conclusion, a multitarget immunosuppressive regimen can allow for combined heart/kidney transplantation across positive CDC crossmatches without evidence of antibody-mediated rejection or significant infection. Longer follow-up will be needed to further support this conclusion.
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spelling pubmed-104795752023-09-06 Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch Yamamoto, Takayuki Pearson, Daniel S. Ababneh, Emad I. Harris, Cynthia Nissaisorakarn, Pitchaphon Mahowald, Grace K. Heher, Yael K. Elias, Nahel Markmann, James F. Lewis, Gregory D. Riella, Leonardo V. Front Nephrol Nephrology Preformed donor-specific antibodies are associated with a higher risk of rejection and worse graft survival in organ transplantation. However, in heart transplantation, the risk and benefit balance between high mortality on the waiting list and graft survival may allow the acceptance of higher immunologic risk donors in broadly sensitized recipients. Transplanting donor-recipient pairs with a positive complement dependent cytotoxic (CDC) crossmatch carries the highest risk of hyperacute rejection and immediate graft loss and is usually avoided in kidney transplantation. Herein we report the first successful simultaneous heart-kidney transplant with a T- and B-cell CDC crossmatch positive donor using a combination of rituximab, intravenous immunoglobulin, plasmapheresis, bortezomib and rabbit anti-thymocyte globulin induction followed by eculizumab therapy for two months post-transplant. In the year following transplantation, both allografts maintained stable graft function (all echocardiographic left ventricular ejection fractions ≥ 65%, eGFR>60) and showed no histologic evidence of antibody-mediated rejection. In addition, the patient has not developed any severe infections including cytomegalovirus or BK virus infection. In conclusion, a multitarget immunosuppressive regimen can allow for combined heart/kidney transplantation across positive CDC crossmatches without evidence of antibody-mediated rejection or significant infection. Longer follow-up will be needed to further support this conclusion. Frontiers Media S.A. 2022-11-28 /pmc/articles/PMC10479575/ /pubmed/37675007 http://dx.doi.org/10.3389/fneph.2022.1047217 Text en Copyright © 2022 Yamamoto, Pearson, Ababneh, Harris, Nissaisorakarn, Mahowald, Heher, Elias, Markmann, Lewis and Riella https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Nephrology
Yamamoto, Takayuki
Pearson, Daniel S.
Ababneh, Emad I.
Harris, Cynthia
Nissaisorakarn, Pitchaphon
Mahowald, Grace K.
Heher, Yael K.
Elias, Nahel
Markmann, James F.
Lewis, Gregory D.
Riella, Leonardo V.
Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch
title Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch
title_full Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch
title_fullStr Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch
title_full_unstemmed Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch
title_short Case report: Successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch
title_sort case report: successful simultaneous heart-kidney transplantation across a positive complement-dependent cytotoxic crossmatch
topic Nephrology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479575/
https://www.ncbi.nlm.nih.gov/pubmed/37675007
http://dx.doi.org/10.3389/fneph.2022.1047217
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