Remarkable 107-year-old kidney with a 49-year of long-term allograph survival through continuous azathioprine monotherapy.

Autor: Nascimento E; Clinical Hospital, Kidney Transplant Unit, Belo Horizonte, MG, Brazil; Faculty of the Hospital Santa Casa, Belo Horizonte, MG, Brazil; IMUNOLAB - Laboratory of Transplant Immunology, Belo Horizonte, MG, Brazil. Electronic address: evaldo@imunolabtx.com.br., Filho AS; Clinical Hospital, Kidney Transplant Unit, Belo Horizonte, MG, Brazil., Lucas-Junior FDM; Clinical Hospital, Kidney Transplant Unit, Belo Horizonte, MG, Brazil., Jobim LFJ; Clinical Hospital of Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: ljobim@hcpa.edu.br., Lasmar MF; Mater Dei Hospital Minas Gerais, Belo Horizonte, MG, Brazil., Tavares-Filho HA; Biocor Hospital, Belo Horizonte, Minas Gerais, Brazil., Fabreti-Oliveira RA; IMUNOLAB - Laboratory of Transplant Immunology, Belo Horizonte, MG, Brazil; Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, MG, Brazil. Electronic address: raquel.fabreti@cienciasmedicasmg.edu.br.
Jazyk: angličtina
Zdroj: Transplant immunology [Transpl Immunol] 2023 Jun; Vol. 78, pp. 101821. Date of Electronic Publication: 2023 Mar 13.
DOI: 10.1016/j.trim.2023.101821
Abstrakt: Background: The main goal of kidney allograft transplantation is to improve survival in patients with end-stage kidney failure. Herein, we report a 49-year long-term allograft survival with non-identical human leukocyte antigens (HLA). The purpose of this study was to report the successful clinical outcome of 49 years of transplant survival in a 79-year-old patient with a 107-year-old kidney undergoing continued immunosuppressive monotherapy.
Material and Methods: The patient was evaluated clinically and immunologically with HLA typing and anti-HLA antibodies before transplantation. Post-transplant, the patient's clinical and immunological survival were monitored for 49 years. The state of the chimerism was assessed using the polymerase chain reaction to amplify 24 short tandem repeats using a DNA thermocycler and DNA analyzer.
Results: The patient and donor were haploidentical and the patient was treated with azathioprine monotherapy. Donor-specific antibodies were detected only for the HLA-DPB1* 03:01 mismatch. This patient developed multiple skin tumors 26 years after transplant, which were successfully treated with topical therapy or surgical removal. The patient developed an intestinal adenocarcinoma 43 years after kidney transplantation, which was surgically removal; six years later, adenocarcinoma was diagnosed in a finger, followed by axillar and hepatic metastases. After 49 years of graft survival of a kidney of 107 years old in a patient with 79 years of age, the patient's health worsened with severe dehydration, anemia, and bacterial infection. The patient was hospitalized with a serum creatinine level of 3.45 mg/dL, urea level of 188 mg/dL, and estimated glomerular filtration rate of 22 mL/1.72 m 2 ; septicemia developed and was treated with antibiotics. The patient had poor clinical progress, was intubated, and later died due to septic shock.
Conclusions: To the best of our knowledge, this is the first case of a 107-year-old kidney, transplanted into a recipient who was treated with azathioprine monotherapy for 49 years.
Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest concerning the publication of this article.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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