Abstract
Belimumab efficacy for the treatment of antibody mediated rejection after heart transplantation: Case report
Highlights
Antibody Mediated Rejection (AMR) is a severe complication after heart transplantation (HTx) due to the production of Donor Specific Antibodies (DSA) by the B-lymphocytes (BL) of the recipient which alters the microvascularisation of the graft
In October 2011, asymptomatic DQ5 DSA was detected with a mean fluorescence intensity (MFI) at 9695, without graft dysfunction nor pathologic sign of AMR leading to add Everolimus to the triple association of immunosuppressive treatment
Because the absence of complete regression of AMR on repeated biopsies and the persistence of signs of graft dysfunction, Belimumab was introduced at a dose of 10 mg/kg IV at D0, D14 and D21 associated to EP and intravenous immunoglobulin (IVIG) twice a week
Summary
Antibody Mediated Rejection (AMR) is a severe complication after heart transplantation (HTx) due to the production of Donor Specific Antibodies (DSA) by the B-lymphocytes (BL) of the recipient which alters the microvascularisation of the graft. In June 2014, the DSA MFI level increased dramatically to 19516 associated to a dyspnea NYHA class II, bilateral legs edema, a LV dysfunction with LVEF decreasing from 70% to 40% and a pAMR2 graded EMB. Because the absence of complete regression of AMR on repeated biopsies and the persistence of signs of graft dysfunction, Belimumab was introduced at a dose of 10 mg/kg IV at D0, D14 and D21 associated to EP and IVIG twice a week. Repeated echocardiographies showed sub-normal LVEF ranging between 40% and 50% and EMB were graded pAMR0 in September and December 2015 despite a still high DSA MFI level. He died in June 2016 after stopping all his treatments due to a severe depression
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