@article {1572,
	title = {Treatment of antibody-mediated rejection with high-dose immunoglobulins in ABO-incompatible liver transplant recipient},
	journal = {Transpl Int},
	volume = {20},
	year = {2007},
	note = {Urbani, Lucio Mazzoni, Alessandro},
	month = {May},
	pages = {467 - 70},
	edition = {39114},
	abstract = {ABO-incompatible liver transplantation (LT) entails high risk of antibody-mediated rejection (AMR) and poor graft survival. Different treatment modalities have been reported, but none with use of a 2-week course of high-dose polyclonal i.v. immunoglobulins (IVIg) associated with plasmapheresis without the use of steroid pulses or monoclonal antibody. A 60-year-old male patient with blood-group O, Caucasian, underwent urgent LT for acute liver failure after hepatectomy for HCV-related hepatocellular carcinoma. He was grafted with a 66-year-old, blood-group A, HCV-positive liver graft. Pretransplant conditioning consisted of plasmapheresis and immunosuppression was triple with tacrolimus (TAC), steroids, and mycophenolate mofetil with anti-IL2-R monoclonal antibodies, plasmapheresis if hemagglutinin level >1:8, and extracorporeal photopheresis. After reduction of liver function tests to baseline, the patient presented a tenfold increase in alanine aminotransferases (ALT) levels 7 days post-transplantation. AMR was confirmed on histology. Treatment consisted of IVIg (1.5 g/Kg/daily for the first 7 days, and 1 g/Kg/daily from day 8 to 14) with a 14-day course of plasmapheresis. No side effect was observed and daily blood IgG levels ranged between 24.4 and 36.4 g/l. At the end of the scheduled course ALT returned to baseline. A control liver biopsy 55 days after LT showed no rejection and replacement of necrosis with fibrous strands. This case may support the role of high-dose IVIg for treatment and/or prophylaxis of severe AMR.},
	keywords = {*ABO Blood-Group System, *Plasmapheresis, Aged, Combined Modality Therapy, Drug Administration Schedule, Fatal Outcome, Graft Rejection / blood / *drug therapy / immunology, Humans, Immunoglobulins, Intravenous / *administration \& dosage, Liver Transplantation / *adverse effects / immunology, Male, Middle Aged},
	issn = {0934-0874 (Print) 0934-0874 (Linking)},
	doi = {TRI447 [pii] 10.1111/j.1432-2277.2006.00447.x},
	author = {Urbani,L. and Mazzoni,A. and De Simone,P. and Catalano,G. and Coletti,L. and Montin,U. and Morelli,L. and Campani,D. and Pollina,L. and Biancofiore,G. and Bindi,L. and Scatena,F. and Filipponi,F.}
}
