Key result
Plasma exchange plus rituximab reverses refractory mixed rejection 12 years post-heart transplant in case report.
Case Report (n=1)
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Reports successful resolution of refractory mixed rejection in a late heart transplant recipient, highlighting plasma exchange and rituximab efficacy.
Heart transplantation (HTx) is an established therapy for stage D heart failure due to recent advances in immunosuppressive regimens. However, antibody-mediated rejection remains an unsolved problem because of its refractoriness to standard immunosuppressive therapy with high mortality and graft loss. We experienced a 16-year old patient with hemodynamic compromise caused by both cellular and antibody-mediated rejection 12 years after HTx. The rejection was refractory to repeated steroid pulse treatment, intravenous immunoglobulin administration, and intensifying immunosuppression including addition of everolimus. Eventually, she was successfully treated with repeated plasma exchange accompanied by a single administration of the anti-CD20 monoclonal antibody rituximab.
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Imamura et al. (2013) conducted a case report in Hemodynamic compromise caused by antibody-mediated and cellular rejection after heart transplantation (n=1). Repeated plasma exchange and a single administration of rituximab was evaluated on Resolution of hemodynamic compromise and rejection. Repeated plasma exchange and a single dose of rituximab successfully treated refractory antibody-mediated and cellular rejection in 1 patient 12 years post-heart transplantation.
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