Successful renal transplantation in a patient with antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis: effect of early plasma exchange and mycophenolate mofetil.

Antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis readily relapses after renal transplantation; the recurrence often causes graft losts. We have reported herein a 53-year-old cadaveric renal allograft recipient. His original disease was ANCA-associated microscopic polyangiitis (MPA), which was proven by renal biopsy. On postoperative day 4, the patient developed dyspnea, hemoptysis, and gross hematuria; the serum p-ANCA titer increased from 1:40 to 1:80. The patient was immediately treated with 5 sessions of plasma exchange. Five days later, the hemoptysis and gross hematuria both disappeared. Serum p-ANCA titer recovered to 1:40. The patient showed stable graft function for 2 months, until mycophenolate mofetil (MMF) was converted to mizoribine (150 mg/d). Seven days after the conversion, the serum creatinine increased from 1.27 to 1.7 mg/dL. Serum p-ANCA increased to 1:160. When mizoribine was converted to MMF, 2 days later the renal function and p-ANCA titer recovered. This case report suggested that early use of plasma exchange combined with MMF was effective to prevent the relapse of ANCA-associated systemic vasculitis after transplantation, and may be helpful to improve transplant outcomes.