Delayed Graft function and Immunosuppressive Drugs in Kidney Transplantation: Cytokine Release Syndrome successfully treated with Adjuvant Hemoadsorption Therapy

Author(s): Jacopo Belfiore, Maria Bindi, Ugo Boggi, Giandomenico Biancofiore

Background: Pre-emptive kidney transplantation improves patient outcomes by avoiding dialysis-related complications; however, it carries a risk of delayed graft function (DGF) and acute rejection, particularly in high-risk recipients. Anti-thymocyte globulin (ATG), frequently used for immunosuppression, may induce cytokine release syndrome (CRS), a severe inflammatory condition associated with multi-organ dysfunction.

Case Presentation: We report the case of a 23-year-old male with IgA nephropathy who developed severe CRS with multi-organ involvement following recurrent ATG administration after kidney transplantation. The patient presented with acute kidney injury, acute respiratory distress syndrome (ARDS), and hemodynamic instability requiring vasopressors and intensive care support. Continuous renal replacement therapy (CRRT) was initiated, and a CytoSorb® hemoadsorption cartridge was integrated into the circuit to modulate the cytokine response. Three consecutive 24- hour hemoadsorption sessions resulted in rapid clinical improvement, including hemodynamic stabilization, restoration of renal function, and respiratory recovery.

Conclusion: This case illustrates the potential role of cytokine adsorption as an adjunctive strategy for managing severe CRS in the post-transplant setting. CytoSorb hemoadsorption contributed to the reversal of multiorgan dysfunction, supporting its application in the treatment of hyperinflammatory complications following immunosuppressive therapy. Further studies are warranted to validate its efficacy and define optimal clinical use.