Failure of Splenectomy in The Treatment of Late Period Humoral Rejection.

Abstract

Humoral mechanisms are increasingly recognized as important mediators of late period graft outcomes. Despite advances in therapy an optimal treatment strategy has not yet been defined. Splenectomy has been previously described in the management of refractory humoral rejection occurring in the early post transplant period. We here describe the case of a patient who presented with mixed cellular and humoral rejection in the late post transplant period. Emergent splenectomy was undertaken in an effort to control humoral rejection without success as indicated by failure of significant improvement in alloantibody levels, progression of antibody mediated graft injury on repeat graft biopsy, and eventual development of graft failure with permanent return to dialysis.Table: No Caption available.Histological comparison of graft and splenic tissue showed significant numbers of functional plasma cells within the allograft but not the spleen, suggesting that the graft itself is a signifcant source of antibody. Our case highlights that late period humoral rejection is a unique entity in which the graft itself functions as a lymphoid organ; as a result, splenectomy, whilst useful in early period humoral rejection, does not appear to be effective.