A case of progressive thrombotic microangiopathy after ABO-incompatible renal transplantation
| Autor: | Seiichiro Tsuchihashi, Akira Suzuki, Naohiko Shimoda, Kanako Kubota, Yuichiro Fukasawa, Tohru Tamaki, Hiromi Fujita, Masayoshi Miura |
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| Rok vydání: | 2011 |
| Předmět: |
Transplantation
Kidney medicine.medical_specialty Thrombotic microangiopathy business.industry medicine.medical_treatment medicine.disease Gastroenterology Tacrolimus Surgery Nephropathy surgical procedures operative medicine.anatomical_structure Internal medicine medicine Plasmapheresis Hemodialysis business Kidney transplantation |
| Zdroj: | Clinical Transplantation. 25:19-22 |
| ISSN: | 0902-0063 |
| Popis: | A 21-yr-old man of blood type O receiving hemodialysis for IgA nephropathy underwent living-related ABO-incompatible (ABOI) renal transplantation from his mother, whose blood type is A. He was negative for flow cross-match, anti-human leukocyte antigen (HLA) antibody, and anti-MICA antibody. Pre-treatment anti-A IgG titer was 1:256. Desensitization consisted of tacrolimus, mycophenolate mofetil, methylprednisolone, rituximab, and plasmapheresis. He developed acute antibody rejection at day 2 post-transplant, which was successfully treated. After renal artery reconstruction surgery at day 91 for renovascular hypertension caused by renal artery stricture, the patient suffered from acute prostatitis, which subsequently induced type III acute antibody-mediated rejection. Even after recovery from the rejection after temporary hemodialysis, graft function progressively deteriorated and consecutive allograft biopsy showed progressive thrombotic microangiopathy (TMA) without any evidence of donor-specific antibody other than anti-A antibody. The tacrolimus dose was kept low for fear of tacrolimus-induced TMA. Despite these efforts, the patient resumed hemodialysis six months' post-transplant. |
| Databáze: | OpenAIRE |
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