Plasmapheresis combination with rituximab in treatment of antibody mediated rejection after renal transplantation: a case report and literature review

Objective To investigate the efficacy of plasmapheresis combination with rituximab in treatment of antibody mediated rejection(AMR)after renal transplantation.Methods Clinical data of a female recipient with AMR was retrospectively analyzed and the related literatures were reviewed.Results A female recipient,who received her first renal transplantation seven years ago,developed renal failure after parturition.She received renal re-transplantation one year later and underwent triple immunosuppression treatment including tacrolimus(FK506)+mycophenolate mofetil(MMF)+ prednisone(Pred)post-transplantation with normal renal function.The recipient developed oliguria and pain of the kidney all of a sudden on day 5 after re-transplantation.The panel reactive antibody(PRA) Ⅰ of this recipient increased to 14.29% with positive donor-specific antibody(DSA).The serum creatinine(Scr) was 606 μmol/L and a single plasma pheresis(2 000 ml) was performed.After that,a single dose of rituximab(500 mg) was administrated to this recipient.Eighteen days after this treatment,PRA and DSA of this recipient were all negative with good kidney function during the follow-up until June 2011.Conclusions Plasmapheresis combined with rituximab shows efficacy in treating AMR after renal transplantation.