González-Roncero F, Suñer M, Bernal G, Cabello V, Toro M, Pereira P, Angel Gentil M
Unidad Gestión Clínica de Nefrourología, Hospitales Universitarios Virgen del Rocío), Sevilla, Spain.
Transplant Proc. 2012 Nov;44(9):2690-4. doi: 10.1016/j.transproceed.2012.09.038.
The occurrence of acute antibody-mediated rejection (AMR), especially in more severe cases, continues to be associated with a poor prognosis for implant survival. Here, we have reported the results of treatment of two patients who developed AMR associated with thrombotic microangiopathy immediately after transplantation. We used a single dose of eculizumab at an early stage jointly with conventional modalities of steroid boluses, plasmapheresis, intravenous immunoglobulin, and rituximab. In both cases, the clinical course was favorable. Eculizumab, a monoclonal antibody with a high affinity for complement protein C5, prevents generation of the final membrane attack complex, blocking this cascade. To date, there are a few reports of the usefulness of eculizumab in AMR. Eculizumab can help to stop endothelial damage, especially in severe cases that show a risk of progression to cortical necrosis, by providing a therapeutic window until the other modalities begin to control the immune response. In our experience, the use of eculizumab can be beneficial in the treatment of AMR.
急性抗体介导的排斥反应（AMR）的发生，尤其是在更严重的病例中，仍然与植入物存活的不良预后相关。在此，我们报告了两名患者在移植后立即发生与血栓性微血管病相关的AMR的治疗结果。我们在早期联合使用单剂量的依库珠单抗以及类固醇冲击、血浆置换、静脉注射免疫球蛋白和利妥昔单抗等传统治疗方法。在这两个病例中，临床过程都很顺利。依库珠单抗是一种对补体蛋白C5具有高亲和力的单克隆抗体，可防止最终膜攻击复合物的产生，阻断这一补体级联反应。迄今为止，关于依库珠单抗在AMR中的有效性的报道较少。依库珠单抗可以帮助阻止内皮损伤，特别是在有进展为皮质坏死风险的严重病例中，通过提供一个治疗窗口期，直到其他治疗方法开始控制免疫反应。根据我们的经验，使用依库珠单抗在AMR的治疗中可能是有益的。
