Successful Treatment of Cardiogenic Shock Caused by Humoral Cardiac Allograft Rejection

Shunsuke Saito; Goro Matsumiya; Norihide Fukushima; Taichi Sakaguchi; Tomoyuki Fujita; Takayoshi Ueno; Shuji Miyagawa; Amane Yamauchi; Yoshiki Sawa

doi:10.1253/circj.CJ-08-0292

Case Reports

Successful Treatment of Cardiogenic Shock Caused by Humoral Cardiac Allograft Rejection

Shunsuke Saito, Goro Matsumiya, Norihide Fukushima, Taichi Sakaguchi, Tomoyuki Fujita, Takayoshi Ueno, Shuji Miyagawa, Amane Yamauchi, Yoshiki Sawa

Author information

Shunsuke Saito
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Goro Matsumiya
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Norihide Fukushima
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Taichi Sakaguchi
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Tomoyuki Fujita
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Takayoshi Ueno
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
Shuji Miyagawa
Division of Organ Transplantation, Biomedical Research Center, Osaka University Graduate School of Medicine
Amane Yamauchi
Department of Pathology, Osaka University Graduate School of Medicine
Yoshiki Sawa
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine

Keywords: Anti-CD20 monoclonal antibody, Anti-donor antibody, Heart transplantation, Humoral rejection, Plasmapheresis

JOURNAL FREE ACCESS

2009 Volume 73 Issue 5 Pages 970-973

DOI https://doi.org/10.1253/circj.CJ-08-0292

View "Advance Publication" version (December 16, 2008).

Details

Abstract

The progress of immunosuppressive therapy has made heart transplantation the standard therapy for end-stage heart failure. However, humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. The present patient developed profound cardiogenic shock requiring extracorporeal life support on the 8th day after heart transplantation. Endomyocardial biopsy revealed no cellular rejection, and complement component C4d was positively stained on the capillary endothelium. The patient was successfully treated with repeated plasmapheresis and administration of anti-CD20 monoclonal antibody, rituximab, as well as with steroid pulse and increased standard immunosuppressive medication. (Circ J 2009; 73: 970 - 973)

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