The antibody mediated rejection (AMR) in intestinal transplantation may lead to graft loss. High titer of panel reactive antibody (PRA) and donor specific antibody (DSA) are related to antibody mediated rejection. To remove antibodies by employing desensitization protocols including intravenous immunoglobulin, plasmapheresis, rituximab and bortezomib has shown potential to prevent and treat AMR in intestinal transplantation. However, many patients remain sensitized regardless of desensitization. Herein we report the first case in which eculizumab was used to salvage AMR in highly desensitization-resistant intestinal re-transplant patient. A 25 years old gentleman status post intestinal transplantation lost graft due to severe AMR. His PRA remained high in spite of prolonged desensitization. He underwent intestinal re-transplantation with high PRA /DSA and positive B cell crossmatch. He developed moderate to severe AMR on postop day 2. Plasmapheresis followed by Eculizumab was used, and graft was salvaged successfully. Rejection has not recurred with 6-month followup with excellent graft function. More interestingly his DSA trended down from 18,000 to negative even though his cPRA remains 97%. Eculizumab offers an alternative to treat AMR in intestinal transplantation.

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