Maruyama Michihiro, Kenmochi Takashi, Saigo Kenichi, Akutsu Naotake, Iwashita Chikara, Ohtsuki Kazunori, Kitamura Hiroshi, Joh Kensuke
Department of Surgery, Clinical Research Center, Chiba East National Hospital, Chiba, Japan.
Clin Transplant. 2006;20 Suppl 15:38-41. doi: 10.1111/j.1399-0012.2006.00548.x.
The patient was a 52-year-old man who received an ABO-compatible but non-identical living-related renal graft from his wife. The graft started to function immediately and the urine output rate was over 100 mL/h. However, this was gradually decreased within 12 h after transplantation. On day 2 post-transplant, the urine output almost stopped. A biopsy specimen revealed lymphocyte dominant cellular infiltration in the interstitium with mild tubulitis (according to Banff's schema grade Ia) and no C4d deposition in peritubular capillaries. Immunohistochemistry disclosed T-cell infiltration. The patient responded to a course of steroid pulse therapy (five days of 500 mg of methylprednisolone). The urine output gradually increased and the level of serum creatinine gradually decreased to 1.0 mg/dL. These clinical and histological findings strongly suggested acute cellular rejection. Acute cellular rejection occurring within 24 h post-transplant is extremely rare. In the present case acute cellular rejection occurred within the first day after living-related renal transplantation and was strongly suspected from histopathological findings in the allograft biopsy specimen.
患者为一名52岁男性，接受了来自其妻子的ABO血型相容但非完全匹配的活体亲属肾移植。移植肾立即开始发挥功能，尿量超过100 mL/h。然而，移植后12小时内尿量逐渐减少。移植后第2天，尿量几乎停止。活检标本显示间质内淋巴细胞为主的细胞浸润，伴有轻度肾小管炎（根据班夫标准为Ia级），肾小管周围毛细血管无C4d沉积。免疫组化显示有T细胞浸润。患者对一疗程的类固醇冲击治疗（500 mg甲泼尼龙，共5天）有反应。尿量逐渐增加，血清肌酐水平逐渐降至1.0 mg/dL。这些临床和组织学表现强烈提示急性细胞排斥反应。移植后24小时内发生急性细胞排斥反应极为罕见。在本病例中，急性细胞排斥反应发生在活体亲属肾移植后的第一天，并且根据移植肾活检标本的组织病理学发现高度怀疑为此病。
