PMID- 19594591
OWN - NLM
STAT- MEDLINE
DCOM- 20091027
LR  - 20090714
IS  - 1399-0012 (Electronic)
IS  - 0902-0063 (Linking)
VI  - 23 Suppl 20
DP  - 2009 Aug
TI  - A case of accelerated acute rejection after ABO-compatible living unrelated 
      kidney transplantation.
PG  - 23-6
LID - 10.1111/j.1399-0012.2009.01004.x [doi]
AB  - A 59-yr-old Japanese woman with chronic renal failure caused by IgA nephropathy 
      and antineutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis 
      underwent kidney transplantation from a living unrelated spousal donor. The blood 
      type was compatible, while the human leukocyte antigen (HLA) typing showed a 5/6 
      locus mismatch. She had become pregnant twice by her donor and had never received 
      blood transfusions. Complement-dependent cytotoxicity cross-match, flow cytometry 
      cross-match (FCXM), and flow panel reactive antibody (PRA) were negative. She 
      initially underwent one week of immunosuppression with mycophenolate mofetil 
      (MMF) and double filtration plasmapheresis (DFPP) immediately before 
      transplantation to reduce the risk of antibody-mediated rejection. Induction 
      therapy consisted of MMF, tacrolimus (TAC), methylprednisolone (MP), and 
      basiliximab. The allograft function was excellent immediately after the 
      operation. However, the urine output and platelet count declined rapidly on 
      post-operative day (POD) 3, while the serum creatinine (sCr) and lactate 
      dehydrogenase levels rose gradually. Subsequently, we could not detect the 
      diastolic arterial flow on Doppler sonography. We diagnosed accelerated acute 
      rejection and treated her with plasma exchange (PEX), intravenous MP pulse 
      therapy, and rituximab. The first episode biopsy on POD 7 revealed acute vascular 
      rejection and acute antibody-mediated rejection (Banff score AMR II). Her urinary 
      excretion increased beginning on POD 13, while the sCr level decreased gradually 
      and reached 0.9 mg/dL on POD 22. In our retrospective analysis, the LAB screen 
      detected donor-specific antibody (DSA). This case suggested that, for successful 
      kidney transplantation in highly sensitized recipients, such as husband-to-wife 
      spousal kidney transplantation with a history of pregnancy, we should keep the 
      risk of AMR in mind, even if the sensitive antibody detection tests are negative.
FAU - Matsuo, Nanae
AU  - Matsuo N
AD  - Division of Kidney and Hypertension, Department of Internal Medicine, Kashiwa 
      Hospital, The Jikei University School of Medicine, Chiba, Japan. 
      nana77m@jikei.ac.jp
FAU - Yamamoto, Hiroyasu
AU  - Yamamoto H
FAU - Kobayashi, Akimitsu
AU  - Kobayashi A
FAU - Yamamoto, Izumi
AU  - Yamamoto I
FAU - Mitome, Jun
AU  - Mitome J
FAU - Maruyama, Yukio
AU  - Maruyama Y
FAU - Hayakawa, Hiroshi
AU  - Hayakawa H
FAU - Miyazaki, Yoichi
AU  - Miyazaki Y
FAU - Utsunomiya, Yasunori
AU  - Utsunomiya Y
FAU - Hosoya, Tatsuo
AU  - Hosoya T
FAU - Yamaguchi, Yutaka
AU  - Yamaguchi Y
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 0 (ABO Blood-Group System)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - ABO Blood-Group System/*immunology
MH  - Acute Disease
MH  - Biopsy, Needle
MH  - Female
MH  - Flow Cytometry
MH  - Follow-Up Studies
MH  - Graft Rejection/*blood/drug therapy/pathology
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Kidney Transplantation/*immunology/pathology
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - Spouses
EDAT- 2009/07/15 09:00
MHDA- 2009/10/29 06:00
CRDT- 2009/07/15 09:00
PHST- 2009/07/15 09:00 [entrez]
PHST- 2009/07/15 09:00 [pubmed]
PHST- 2009/10/29 06:00 [medline]
AID - CTR1004 [pii]
AID - 10.1111/j.1399-0012.2009.01004.x [doi]
PST - ppublish
SO  - Clin Transplant. 2009 Aug;23 Suppl 20:23-6. doi: 
      10.1111/j.1399-0012.2009.01004.x.