The utility of splenectomy as rescue treatment for severe acute antibody mediated rejection

J. E. Locke, A. A. Zachary, M. Haas, J. K. Melancon, Daniel Warren, C. E. Simpkins, Dorry Segev, R. A. Montgomery

Research output: Contribution to journalArticle


Antibody-mediated rejection (AMR) after desensitization for a positive crossmatch (+XM) live donor renal transplant can be severe and result in sudden onset oliguria and loss of the allograft. Attempts to rescue these kidneys using plasmapheresis (PP) and IVIg may be ineffective due to the magnitude of antibody burden that must be controlled to prevent renal thrombosis or cortical necrosis. We review our experience using splenectomy combined with PP/IVIg as rescue therapy for patients experiencing an acute deterioration in renal function and a rise in donor-specific antibody within the first posttransplant week after desensitization for a +XM. Five patients underwent immediate splenectomy followed by PP/IVIg and had return of allograft function within 48 h of the procedure. Emergent splenectomy followed by PP/IVIg may be an effective treatment for reversing severe AMR.

Original languageEnglish (US)
Pages (from-to)842-846
Number of pages5
JournalAmerican Journal of Transplantation
Issue number4
StatePublished - Apr 2007


ASJC Scopus subject areas

  • Immunology

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