P-173

Hypersensitivity to rabbit anti-thymocyte globulin in an islet transplant recipient

S. Soleimanpour, D. Sekiguchi, D. LaRosa, E. Luning Prak, A. Naji, M. Rickels
University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Objective: To describe a case of hypersensitivity to rabbit anti-thymocyte globulin (rATG) occurring in the context of islet transplantation.

Methods: A 36-year-old woman with type 1 diabetes was admitted for islet transplantation. rATG was administered the first day (1.5 mg/kg) with methylprednisolone (2 mg/kg), and on the second day (1.5 mg/kg) without glucocorticoid to avoid potential toxicity to the anticipated islet transplant.

Results: At the end of the rATG infusion on the second day she developed hives over her face, chest and back, and tender erythema at her i.v. site. Islet transplantation was not performed. She reported exposure to a pet rabbit for 2 years in childhood. Overnight, fever developed and the rash evolved into an erythematous morbilliform eruption affecting the torso. Serum CRP and the ESR were elevated; serum C3 and C4 were normal. She received prednisone 50 mg with subsequent resolution of the rash, and completed 3 more 30 mg doses. Nine days after her initial reaction, she developed a recurrence of the rash and fever now with arthralgias; serum levels of C3 and C4 had fallen. Methylprednisolone 125 mg twice was required for symptom improvement, and was gradually tapered as prednisone over the next 4 weeks. One week after the second reaction serum levels of C3 and C4 and the ESR were normal. Five months after the initial attempt at islet transplantation, she returned to receive 7,879 IEs/kg via portal vein infusion under basiliximab (20 mg twice), tacrolimus and sirolimus immunosuppression, and has maintained insulin-independence for more than 6 months post-transplant.

Conclusions: Our patient’s apparent immediate, type 1, hypersensitivity reaction to rATG was followed by immune complex, type 3, hypersensitivity (serum sickness) requiring high dose glucocorticoids. Canceling the initial islet infusion proved wise, and the patient subsequently did well with islet transplantation under an alternative induction agent.

P-173

Hypersensitivity to rabbit anti-thymocyte globulin in an islet transplant recipient

S. Soleimanpour, D. Sekiguchi, D. LaRosa, E. Luning Prak, A. Naji, M. Rickels
University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Objective: To describe a case of hypersensitivity to rabbit anti-thymocyte globulin (rATG) occurring in the context of islet transplantation.

Methods: A 36-year-old woman with type 1 diabetes was admitted for islet transplantation. rATG was administered the first day (1.5 mg/kg) with methylprednisolone (2 mg/kg), and on the second day (1.5 mg/kg) without glucocorticoid to avoid potential toxicity to the anticipated islet transplant.

Results: At the end of the rATG infusion on the second day she developed hives over her face, chest and back, and tender erythema at her i.v. site. Islet transplantation was not performed. She reported exposure to a pet rabbit for 2 years in childhood. Overnight, fever developed and the rash evolved into an erythematous morbilliform eruption affecting the torso. Serum CRP and the ESR were elevated; serum C3 and C4 were normal. She received prednisone 50 mg with subsequent resolution of the rash, and completed 3 more 30 mg doses. Nine days after her initial reaction, she developed a recurrence of the rash and fever now with arthralgias; serum levels of C3 and C4 had fallen. Methylprednisolone 125 mg twice was required for symptom improvement, and was gradually tapered as prednisone over the next 4 weeks. One week after the second reaction serum levels of C3 and C4 and the ESR were normal. Five months after the initial attempt at islet transplantation, she returned to receive 7,879 IEs/kg via portal vein infusion under basiliximab (20 mg twice), tacrolimus and sirolimus immunosuppression, and has maintained insulin-independence for more than 6 months post-transplant.

Conclusions: Our patient’s apparent immediate, type 1, hypersensitivity reaction to rATG was followed by immune complex, type 3, hypersensitivity (serum sickness) requiring high dose glucocorticoids. Canceling the initial islet infusion proved wise, and the patient subsequently did well with islet transplantation under an alternative induction agent.