Abstract: FR-PO1186
Eculizumab as a Rescue Therapy for Early Antibody-Mediated Rejection After Kidney Transplantation
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Patel, Pooja V., Brown University, Providence, Rhode Island, United States
- Bhattarai, Shreeyukta, Brown University, Providence, Rhode Island, United States
- Dailey, Jennifer, Brown University, Providence, Rhode Island, United States
- Merhi, Basma Omar, Brown University, Providence, Rhode Island, United States
Introduction
Early antibody-mediated rejection (ABMR) is a severe complication after kidney transplantation leading to graft dysfunction and loss if not promptly and aggressively treated.
Case Description
A 66 y/o female with a history of ESKD secondary to diabetes underwent a live donor kidney transplant. She has PRA of 65% and low titer of donor-specific antibodies (DSA) to DR4 and DQ8 (<1000 MFI) with negative crossmatch prior to transplant. She received induction with Basiliximab, solumedrol, IVIG and was maintained on Prednisone, Envarsus and Mycophenolate Mofetil. Postoperative course was complicated by decreased urine output and delayed graft function requiring dialysis on postoperative day four. Allograft US with doppler showed normal parenchyma with preserved vascular flow. Diagnostic allograft biopsy revealed subcapsular cortical necrosis concerning for thrombotic microangiopathy, glomerulitis and peritubular capillaritis with negative C4d staining, meeting the criteria of ABMR (Fig 1). Repeated DSA showed class 1 and 2 antibodies against B45 (7000 MFI), B76 (3000 MFI), DQ7 (7000 MFI), and DQ8 (5000 MFI). She was treated with six doses of Eculizumab, six cycles of plasmapheresis/IVIG, and single dose of rituximab. One month later, surveillance biopsy demonstrated resolution of histologic evidence of ABMR. At six months, the patient maintains excellent graft function with a serum cr of 1 mg/dL (Fig 2) and negative DSA.
Discussion
Early active ABMR is a rare but severe cause of early allograft loss driven by activation of memory B cells and an increase in DSA, causing complement-mediated endothelial injury. Eculizumab has been reported as a rescue therapy in case reports and small series. Our case highlights the early detection of ABMR with abrupt DSA increase and the prompt use of eculizumab as an effective therapy to salvage the allograft.