Graft survival rates of ABO‐incompatible (ABO‐I) living‐related kidney transplantations have greatly improved with the progress of immunosuppressive protocols. However, there are several case reports in which hyperacute rejections (HAR) or delayed hyperacute rejections (DHAR) occurred with immunosuppression, and acute humoral rejection is a risk factor for early graft loss in ABO‐I kidney transplantations. We report a case of early graft loss after ABO‐I kidney transplantation. A 51‐yr‐old male received an ABO‐I kidney transplant from his wife. Graft function deteriorated immediately after surgery and HAR developed. Although plasma exchange and steroid pulse were performed, graft function did not recover. A renal biopsy on postoperative day (POD) 4 indicated compatible findings with HAR. Renal function was deemed irreversible and the renal graft was removed on POD 7. A biopsy performed one h after transplantation revealed a clot in the glomerulus. As this was a case of ABO‐I transplantation without human leukocyte antigen class I and II antibodies in the pre‐ and postoperative flow panel reactive antibody, HAR was most likely caused by the presence of anti‐blood group antibodies. The preoperative anti‐A antibody value of ×64 was rather high in the present case. There is no clear standard for preoperative antibody values and it is difficult to predict prognosis preoperatively with the recent use of strong immunosuppressives. Although the mechanism of onset is unclear in this case, it is believed that the antibody titer should be reduced as much as possible prior to transplantation.
Horie K, Fujita T, Tsuyuki M, Nishio F, Watanabe T, Kanou Y, Kuzuya A, Sato M, Kinukawa T. Plasma cell‐rich acute rejection after renal transplantation in a patient with pyoderma gangrenosum: a case report. Clin Transplant 2010: 24 (Suppl. 22): 39–43. © 2010 John Wiley & Sons A/S. Abstract: A 40‐yr‐old female received a living‐related renal transplantation on January 29, 2008. She had type I diabetes mellitus and pyoderma gangrenosum (PG). Induction immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil, basiliximab, and prednisolone. Intravenous methylprednisolone pulse therapy was administered to prevent ulceration at the surgical site. The postoperative outcome was almost uneventful, and renal graft function was well preserved for 11 months. Her graft function deteriorated on December 24, 2008 and thus an episode biopsy was performed. The histopathological findings were consistent with plasma cell‐rich acute rejection (PCAR). During hospitalization, it was noted that the patient was non‐compliant. We then performed steroid pulse therapy, and her graft function and histological findings improved. This is the first report of PCAR in a patient with PG who received a renal allograft. It was thought that PCAR was triggered because of her non‐compliance. Thus, we should recognize the importance of enhancing compliance in transplant recipients.
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