致敏患者有发生急性抗体介导的排斥反应（AMR）的高度危险。在大多数病例中，排斥反应事件是轻微的，且对于短期内血浆置换（PP）/低剂量的IVIg治疗有反应。但是，有一些患者发生严重的AMR，即刻出现少尿。我们先前报道了采用急诊脾脏切除治疗这种类型的急性AMR用于挽救患者的移植物。但是，不是所有患者都适合做脾脏切除。我们这里报道了一例患者采用了eculizumab（一种补体蛋白C5的单抗，能够抑制MAC的形成）联合PP/IVIg挽救了发生严重AMR的一枚移植肾。我们发现在使用eculizumab后，C5b-C9（MAC）复合物沉积显著下降。

Locke JE, Magro CM, Singer AL, Segev DL, Haas M, Hillel AT, King KE, Kraus E, Lees LM, Melancon JK, Stewart ZA, Warren DS, Zachary AA, Montgomery RA.
Department of Surgery, Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, MD.

Desensitized patients are at high risk of developing acute antibody-mediated rejection (AMR). In most cases, the rejection episodes are mild and respond to a short course of plasmapheresis (PP) / low-dose IVIg treatment. However, a subset of patients experience severe AMR associated with sudden onset oliguria. We previously described the utility of emergent splenectomy in rescuing allografts in patients with this type of severe AMR. However, not all patients are good candidates for splenectomy. Here we present a single case in which eculizumab, a complement protein C5 antibody that inhibits the formation of the membrane attack complex (MAC), was used combined with PP/IVIg to salvage a kidney undergoing severe AMR. We show a marked decrease in C5b-C9 (MAC) complex deposition in the kidney after the administration of eculizumab.