Eculizumab Rescue Therapy in ABO Incompatible Transplant- A Case Report

ABO-incompatible (ABOi) kidney transplants can be complicated by early onset of antibody-mediated rejection and thrombotic microangiopathy. Traditional management with plasmapheresis often fails, resulting in graft loss. We report a case of acute antibody-mediated rejection/thrombotic microangiopathy in ABOi transplant in the early post-transplant period, rescued with Eculizumab. Only 2 doses were given: an initial dose of 900 mg and a second dose of 600 mg. The patient’s hematological parameters and graft function stabilised, and he maintains a stable serum creatinine of 1.4 mg/dL at 6-month follow-up. We conclude that in some cases fewer doses of eculizumab (2 doses) can achieve successful graft rescue in cases of ABOi thrombotic microangiopathy.