The use of antibody to complement protein C5 for salvage treatment of severe antibody-mediated rejection

Am J Transplant. 2009 Jan;9(1):231-5. doi: 10.1111/j.1600-6143.2008.02451.x. Epub 2008 Oct 31.


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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Complement C5 / immunology*
  • Female
  • Graft Rejection / immunology
  • Graft Rejection / therapy*
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Kidney Transplantation*
  • Living Donors
  • Male
  • Salvage Therapy


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Complement C5
  • Immunoglobulins, Intravenous
  • eculizumab