Stendahl Gall, Berger Stuart, Ellis Tom, Gandy Kimberly, Mitchell Michael, Tweddell James, Zangwill Steven
Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Prog Transplant. 2010 Sep;20(3):288-91. doi: 10.1177/152692481002000314.
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.
在一名患有镰状细胞病的10岁非裔美国女孩心脏移植2年后观察到体液排斥反应。出现了血流动力学损害，患者在入院后24小时内开始接受体外膜肺氧合治疗。最初认为细胞排斥是病因，于是开始给予抗胸腺细胞球蛋白和大剂量类固醇。人类白细胞抗原抗体分析显示供体特异性I类和II类抗体滴度很高。开始采用血浆置换、静脉注射免疫球蛋白和利妥昔单抗对抗体介导的排斥反应进行积极治疗。患者出现感染的临床症状，并接受了抗菌、抗病毒和抗真菌药物治疗。胸部计算机断层扫描提示曲霉菌感染。患者接受了左上叶切除术。患者康复良好，在接受心脏移植4年后情况一直不错。对于出现血流动力学损害的心脏移植患者，应尽早考虑抗体介导的排斥反应，积极的抗体和B细胞导向治疗可能有效。警惕继发感染，尤其是在排斥反应治疗期间，至关重要。
