Imamura Teruhiko, Kinugawa Koichiro, Kato Naoko, Kagami Yukie, Endo Miyoko, Kaneko Nobuyuki, Minatsuki Shun, Muraoka Hironori, Inaba Toshiro, Maki Hisataka, Hatano Masaru, Doi Kent, Yao Atsushi, Takazawa Yutaka, Ono Minoru, Kyo Shunei, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo.
Int Heart J. 2013;54(5):328-31. doi: 10.1536/ihj.54.328.
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.
由于免疫抑制方案的最新进展，心脏移植（HTx）已成为治疗D期心力衰竭的既定疗法。然而，抗体介导的排斥反应仍然是一个未解决的问题，因为它对标准免疫抑制治疗具有难治性，死亡率高且移植物丢失。我们遇到一名16岁的患者，在心脏移植12年后因细胞和抗体介导的排斥反应导致血流动力学受损。这种排斥反应对反复的类固醇脉冲治疗、静脉注射免疫球蛋白以及强化免疫抑制（包括添加依维莫司）均无效。最终，她通过反复血浆置换并单次给予抗CD20单克隆抗体利妥昔单抗成功得到治疗。
