Miura Masayoshi, Kubota Kanako C, Itoh Tomoo, Ono Takenori, Morita Ken, Watarai Yoshihiko, Harada Hiroshi, Hirano Tetsuo, Nonomura Katsuya
Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Clin Transplant. 2006;20 Suppl 15:33-7. doi: 10.1111/j.1399-0012.2006.00547.x.
A 30-yr-old woman underwent kidney transplantation from a flow cytometric lymphocyte crossmatch-negative donor. Immunosuppression consisted of tacrolimus, mycophenolate mofetil, basiliximab and three days of steroid. On day 5 post-transplant, she developed acute rejection and underwent anti-rejection therapy consisting of steroid pulse and deoxyspurgualin. Retrospective analyses of anti-human leukocyte antigen antibody revealed high flow panel reactive antibody (PRA) in the pre-transplant serum without donor specific antibody (DSA) and positive DSA at the time of rejection. Anti-rejection therapy was successful in treating cellular rejection but her graft function further deteriorated after three months post-transplant and graft biopsy revealed chronic allograft nephropathy with positive staining for C4d in peritubular capillary, suggesting the presence of chronic antibody-mediated rejection. Pre-transplant positive flow PRA without DSA may also be a risk for acute and chronic rejection.
一名30岁女性接受了来自流式细胞术淋巴细胞交叉配型阴性供体的肾移植。免疫抑制方案包括他克莫司、霉酚酸酯、巴利昔单抗以及三天的类固醇。移植后第5天，她发生了急性排斥反应，并接受了由类固醇冲击治疗和脱氧精胍菌素组成的抗排斥治疗。对人类白细胞抗原抗体的回顾性分析显示，移植前血清中存在高群体反应性抗体（PRA），但无供体特异性抗体（DSA），而在排斥反应发生时DSA呈阳性。抗排斥治疗成功地治疗了细胞性排斥反应，但移植后三个月她的移植肾功能进一步恶化，移植肾活检显示慢性移植肾肾病，肾小管周围毛细血管C4d染色阳性，提示存在慢性抗体介导的排斥反应。移植前无DSA的阳性流式PRA也可能是急性和慢性排斥反应的一个风险因素。
