Severe Intraoperative Anaphylaxis Related to Thymoglobulin during Living Donor Kidney Transplantation

• Main Authors: Muhammad I. Saeed, Ryan D. Nicklas, Vikas Kumar, Rajan Kapoor, Imran Y. Gani
• Format: Article
• Language: English
• Published: MDPI AG 2020-08-01
• Series: Antibodies
• Subjects: living donor kidney transplantation; rabbit anti-thymocyte globulin; anaphylactic shock
• Online Access: https://www.mdpi.com/2073-4468/9/3/43

Anaphylaxis secondary to thymoglobulin (anti-thymocyte globulin) is a rare condition that can be life threatening. Thymoglobulin is a rabbit-derived T-cell depleting polyclonal immunoglobulin. It is commonly used for induction immunosuppression and/or for treatment of acute rejection in renal transplantation. We report a case of a living kidney transplant recipient who developed intraoperative anaphylactic shock secondary to thymoglobulin. The patient had a history of pet rabbit exposure. This case report highlights the importance of prompt identification and management of intraoperative anaphylaxis, which is key to a successful outcome. Induction immunosuppression selection based on patient characteristics is important. Communication between the anesthesia team and surgeons played a key role in stopping the donor surgery.