Thrombotic microangiopathy associated with anticardiolipin antibody in a kidney transplant recipient with polycythemia

akihiro tsuchimoto, Yuta Matsukuma, Kenji Ueki, Takehiro Nishiki, Atsushi Doi, Yasuhiro Okabe, Masafumi Nakamura, Kazuhiko Tsuruya, Toshiaki Nakano, Takanari Kitazono, Kosuke Masutani

研究成果: ジャーナルへの寄稿記事

抄録

Thrombotic microangiopathy (TMA) develops from various etiologies, and it is often difficult to distinguish the etiology of TMA in kidney transplantation. Antiphospholipid syndrome (APS) is one of the differential diagnoses for TMA that may cause acute loss of graft function or fatal thrombotic complications. This report details a 66-year-old male patient with polycythemia after ABO-incompatible kidney transplantation. Antibody screening tests were negative before transplant. Despite administration of an adequate desensitization therapy including plasmapheresis and rituximab, he developed acute graft dysfunction on postoperative day 112 and graft biopsy revealed prominent microvascular inflammation in the glomerular capillaries without immunoglobulin deposits. Flow cytometric panel-reactive antibody screening failed to detect donor-specific antibodies at both pre-transplant and episode biopsies. Anticardiolipin antibody was repeatedly positive, but neither thrombosis nor previous thrombotic episodes were detected. After excluding several differential diagnoses, the graft dysfunction with unexplained TMA was treated with steroid pulse, plasmapheresis and rituximab re-induction. Anticardiolipin antibody disappeared after this intensive treatment and graft function recovered gradually and stabilized for 52 months. This report suggests that asymptomatic anticardiolipin antibody may be associated with acute graft dysfunction. Even if thrombotic episodes are not observed, an exist of anticardiolipin antibody may be one of the risk factors of renal TMA after kidney transplantation.

元の言語英語
ページ(範囲)1-7
ページ数7
ジャーナルCEN case reports
8
発行部数1
DOI
出版物ステータス出版済み - 2 1 2019

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Thrombotic Microangiopathies
Anticardiolipin Antibodies
Polycythemia
Transplants
Kidney
Kidney Transplantation
Plasmapheresis
Antibodies
Differential Diagnosis
Biopsy
Antiphospholipid Syndrome
Transplant Recipients
Immunoglobulins
Thrombosis
Steroids
Tissue Donors
Inflammation

All Science Journal Classification (ASJC) codes

  • Nephrology

これを引用

Thrombotic microangiopathy associated with anticardiolipin antibody in a kidney transplant recipient with polycythemia. / tsuchimoto, akihiro; Matsukuma, Yuta; Ueki, Kenji; Nishiki, Takehiro; Doi, Atsushi; Okabe, Yasuhiro; Nakamura, Masafumi; Tsuruya, Kazuhiko; Nakano, Toshiaki; Kitazono, Takanari; Masutani, Kosuke.

:: CEN case reports, 巻 8, 番号 1, 01.02.2019, p. 1-7.

研究成果: ジャーナルへの寄稿記事

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abstract = "Thrombotic microangiopathy (TMA) develops from various etiologies, and it is often difficult to distinguish the etiology of TMA in kidney transplantation. Antiphospholipid syndrome (APS) is one of the differential diagnoses for TMA that may cause acute loss of graft function or fatal thrombotic complications. This report details a 66-year-old male patient with polycythemia after ABO-incompatible kidney transplantation. Antibody screening tests were negative before transplant. Despite administration of an adequate desensitization therapy including plasmapheresis and rituximab, he developed acute graft dysfunction on postoperative day 112 and graft biopsy revealed prominent microvascular inflammation in the glomerular capillaries without immunoglobulin deposits. Flow cytometric panel-reactive antibody screening failed to detect donor-specific antibodies at both pre-transplant and episode biopsies. Anticardiolipin antibody was repeatedly positive, but neither thrombosis nor previous thrombotic episodes were detected. After excluding several differential diagnoses, the graft dysfunction with unexplained TMA was treated with steroid pulse, plasmapheresis and rituximab re-induction. Anticardiolipin antibody disappeared after this intensive treatment and graft function recovered gradually and stabilized for 52 months. This report suggests that asymptomatic anticardiolipin antibody may be associated with acute graft dysfunction. Even if thrombotic episodes are not observed, an exist of anticardiolipin antibody may be one of the risk factors of renal TMA after kidney transplantation.",
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AU - Nishiki, Takehiro

AU - Doi, Atsushi

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AU - Nakamura, Masafumi

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AU - Nakano, Toshiaki

AU - Kitazono, Takanari

AU - Masutani, Kosuke

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