Barraclough Katherine A, Robinson Katherine L, Dowling John P, Schwarer Anthony P, Perry Gregory J
Department of Renal Medicine, Bone Marrow Transplant Program, Alfred Hospital, Melbourne, Australia.
Am J Kidney Dis. 2006 Nov;48(5):822-6. doi: 10.1053/j.ajkd.2006.08.025.
A 28-year-old woman underwent peripheral-blood stem cell transplantation from her HLA-identical sister for cytogenetic progression of Fanconi anemia. She had received a living-related renal allograft from her father 2 years previously. Nine days after peripheral-blood stem cell transplantation, she developed acute renal failure secondary to acute rejection. Severe microangiopathic hemolysis developed, and cyclosporine therapy was discontinued. Renal biopsy showed humoral rejection and thrombotic microangiopathy. Despite daily plasmapheresis and immunosuppression, she remained dialysis dependent. The renal graft was removed, with rapid resolution of microangiopathic hemolysis. At no stage was there evidence of acute graft-versus-host disease. We speculate that the engrafting third-party hematopoiesis produced acute renal allograft rejection with secondary microangiopathic hemolysis through a graft-versus-graft mechanism.
一名28岁女性因范可尼贫血细胞遗传学进展，接受了来自其HLA全相合姐姐的外周血干细胞移植。她在两年前接受了来自其父亲的活体亲属肾移植。外周血干细胞移植九天后，她因急性排斥反应继发急性肾衰竭。出现了严重的微血管病性溶血，停用了环孢素治疗。肾活检显示体液性排斥反应和血栓性微血管病。尽管每日进行血浆置换和免疫抑制治疗，她仍依赖透析。切除了肾移植器官，微血管病性溶血迅速消退。在任何阶段均无急性移植物抗宿主病的证据。我们推测，植入的第三方造血通过移植物抗移植物机制，导致了急性肾移植排斥反应并继发微血管病性溶血。
