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A case of progressive thrombotic microangiopathy after ABO‐incompatible renal transplantation
Author(s) -
Miura Masayoshi,
Fujita Hiromi,
Suzuki Akira,
Kubota Kanako C.,
Fukasawa Yuichiro,
Shimoda Naohiko,
Tsuchihashi Seiichiro,
Tamaki Tohru
Publication year - 2011
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2011.01454.x
Subject(s) - medicine , thrombotic microangiopathy , abo blood group system , transplantation , microangiopathy , kidney transplantation , cardiology , surgery , disease , endocrinology , diabetes mellitus
Miura M, Fujita H, Suzuki A, Kubota KC, Fukasawa Y, Shimoda N, Tsuchihashi S, Tamaki T. A case of progressive thrombotic microangiopathy after ABO‐incompatible renal transplantation.
Clin Transplant 2011: 25 (Suppl. 23): 19–22.
© 2011 John Wiley & Sons A/S. Abstract: 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.