Antibody-mediated rejection after ABO-incompatible pediatric living donor liver transplantation for propionic acidemia: A case report
Corresponding Author
Masaki Honda
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Masaki Honda, Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Tel.: +81 96 373 5616
Fax: +81 96 373 5616
E-mail: [email protected]
Search for more papers by this authorSeisuke Sakamoto
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorRieko Sakamoto
Department of Pediatrics, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorShirou Matsumoto
Department of Pediatrics, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorTomoaki Irie
Department of Pediatric Surgery, Kumamoto City Hospital, Kumamoto, Japan
Search for more papers by this authorKoushi Uchida
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorKeita Shimata
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorSeiichi Kawabata
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorKaori Isono
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorShintaro Hayashida
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorHidekazu Yamamoto
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorFumio Endo
Department of Pediatrics, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorYukihiro Inomata
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorCorresponding Author
Masaki Honda
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Masaki Honda, Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Tel.: +81 96 373 5616
Fax: +81 96 373 5616
E-mail: [email protected]
Search for more papers by this authorSeisuke Sakamoto
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorRieko Sakamoto
Department of Pediatrics, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorShirou Matsumoto
Department of Pediatrics, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorTomoaki Irie
Department of Pediatric Surgery, Kumamoto City Hospital, Kumamoto, Japan
Search for more papers by this authorKoushi Uchida
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorKeita Shimata
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorSeiichi Kawabata
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorKaori Isono
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorShintaro Hayashida
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorHidekazu Yamamoto
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorFumio Endo
Department of Pediatrics, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorYukihiro Inomata
Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Search for more papers by this authorAbstract
We herein present the case of a four-yr-old boy with PA who developed AMR after ABO-incompatible LDLT despite undergoing B cell desensitization using rituximab. Although the CD19+ lymphocyte count decreased to 0.1% nine days after the administration of rituximab, he developed a high fever which was accompanied by arthralgia due to a streptococcal infection 13 days after rituximab prophylaxis. After the clearance of the infection, he underwent ABO-incompatible LDLT 36 days after the administration of rituximab. The CD19+ lymphocyte count just prior to LDLT was 1.2%. He developed AMR five days after LDLT, and the antidonor-type IgM and IgG antibody titers increased to 1:1024 and 1:1024, respectively. He was treated by plasma exchange, IVIG, steroid pulse therapy, and rituximab re-administration; however, his liver dysfunction continued. Despite intensive treatment, he died due to complicated abdominal hernia, acute renal failure, and ARDS. This case suggests that a streptococcal infection may induce the activation of innate immune responses; thus, additional desensitization therapy should be considered prior to ABO-incompatible LDLT if B cell reactivation is suspected.
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