Humoral rejection after pediatric heart transplantation: a case report.

Gall Stendahl*, Stuart Berger, Tom Ellis, Kimberly Gandy, Michael Mitchell, James Tweddell, Steven Zangwill

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Humoral rejection was observed 2 years after heart transplantation in a 10-year-old African American girl with sickle cell disease. Hemodynamic compromise developed, and the patient started treatment with extracorporeal membrane oxygenation within 24 hours of admission. With cellular rejection initially believed to be the cause, administration of thymoglobulin and high-dose steroids was initiated. Human leukocyte antigen antibody analysis revealed high titers of donor-specific class I and II antibodies. Aggressive treatment for antibody-mediated rejection was started with plasmapheresis and administration of intravenous immune globulin and rituximab. The patient displayed clinical signs of infection and was treated with antimicrobial, antiviral, and antifungal agents. Computed tomography of the chest suggested asperigillous infection. The patient underwent a left upper lobectomy. The patient recovered and has done well, now 4 years after having received the heart transplant. Antibody-mediated rejection should be considered early in heart transplant patients presenting with hemodynamic compromise and may respond to aggressive antibody and B cell-directed therapy. Vigilance for secondary infections, especially during treatment for rejection, is crucial.

Original languageEnglish (US)
Pages (from-to)288-291
Number of pages4
JournalProgress in transplantation (Aliso Viejo, Calif.)
Volume20
Issue number3
DOIs
StatePublished - Sep 2010

ASJC Scopus subject areas

  • Transplantation

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