Antibody-mediated rejection after cardiac transplant: Treatment with immunoadsorption, intravenous immunoglobulin, and anti-thymocyte globulin.

Antibody-mediated rejection of allograft is a poorly understood problem after cardiac transplantation that complicates the postoperative course and impairs the graft function and overall survival. Although plasmapheresis and intravenous immunoglobulins have been used as standard therapies for years, there is no consensus about antibody-mediated rejection therapy and most transplantation centers have their own protocols. We describe herein a successful treatment for an acute antibody-mediated rejection of cardiac allograft combining immunoadsorption, intravenous immunoglobulins, and anti-thymocyte globulin, which manifested with polymorphic ventricular tachycardia and right ventricular dysfunction.