[HEART TRANSPLANTATION: HUMORAL REJECTION - A CASE REPORT]

Area of Science:

• Cardiology
• Immunology
• Transplantation Medicine

Context:

• Allograft rejection remains a significant obstacle in heart transplantation.
• Antibody-mediated rejection (AMR) poses a severe threat, leading to cardiac allograft vasculopathy (CAV).
• Diagnosis relies on biopsy findings and donor-specific antibody detection.

Purpose:

• To report a case of severe, refractory antibody-mediated rejection (AMR) with diffuse cardiac allograft vasculopathy (CAV) following heart transplantation.
• To illustrate the challenges in managing treatment-resistant AMR.
• To highlight the limited therapeutic options for advanced CAV.

Summary:

• A 48-year-old male developed severe AMR and diffuse CAV 1.5 years post-heart transplant, presenting with heart failure and coronary events.
• Standard first-line treatments (corticosteroids, ATG, IVIG, plasmapheresis, rituximab) were insufficient.
• Additional therapies including photopheresis and bortezomib failed, and the patient's condition deteriorated, leading to death.

Impact:

• This case underscores the critical need for novel therapeutic strategies for refractory AMR and CAV.
• It highlights the limitations of current treatment protocols in severe cases.
• The report emphasizes the poor prognosis associated with advanced cardiac allograft vasculopathy.