Reversible severe vascular rejection after plasmpheresis

ABSTRACT

Vascular rejection in a transplanted child is frequently associated with bad prognosis on the short and long term. All threrapeutic modalities available nowadays as monoclonal antibodies, intravenous cyclosporine or plasma exchange have given conflicting results. We report the case of a boy who was transplanted from his mother at the age of three. His primary disease was a cortico resistant rapidly progressive glomerulonephritis; the immediate postoperative period was satisfactory but he developed a severe vascular rejection on day 5 post transplantation while on triple immunosuppression therapy associating antithymocyte globuline prednisolone and azathioprine. Acute vascular rejection was corticoresistant but responded well to plasma exchange. In our patients we believe that plasmaphersis was efficacious on the reversibility of vascular rejection and moreover that he had not responded to corticotherapy even a week post methylprednisolone in the absence of any change in immunosuppression during plasmapheresis. No randomized study was realized until now to prove the efficacy of plasmapheresis in children with vascular rejection. The sporadic cases reported on the reversibility of such rejection after plasmapheresis, the innocuity of this therapy, if well performed in children encourage us to consider this treatment modality in resistant vascular rejection