Division of Nephrology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.
Nephrol Dial Transplant. 2010 Dec;25(12):4109-13. doi: 10.1093/ndt/gfq517. Epub 2010 Sep 3.
Pre-existing diffuse proliferative glomerulonephritis (DPGN) in a potential deceased kidney donor has been considered a contraindication for transplantation. We report a case of a patient who underwent a successful deceased donor renal transplantation from a donor with history of systemic lupus erythematosus (SLE) whose baseline biopsy revealed DPGN. Although the histology was relatively benign in the procurement kidney biopsy done by frozen section, the final light microscopy available after transplantation showed diffuse proliferative lupus nephritis, WHO class IV, with 44% crescents. The post-transplant course was complicated by delayed allograft function requiring haemodialysis for the first week. A repeat biopsy performed after 4 months of transplant showed resolution of the proliferative lesions in the glomeruli with disappearance of the crescents. At 5.5 years of follow-up, the patient's creatinine has been stable at 2.0 mg/dL (176.8 μmol/L), but he has persistent proteinuria.
潜在的已故肾脏供体中预先存在的弥漫性增生性肾小球肾炎 (DPGN) 一直被认为是移植的禁忌症。我们报告了一例系统性红斑狼疮 (SLE) 病史患者的成功接受已故供体肾移植的病例，该患者的基线活检显示 DPGN。尽管通过冷冻切片进行的供体肾活检的组织学相对良性，但移植后获得的最终光镜检查显示弥漫性增生性狼疮性肾炎，WHO 分级 IV，新月体 44%。移植后病程复杂，出现延迟性移植物功能障碍，需要在第一周进行血液透析。移植后 4 个月进行的重复活检显示肾小球内的增生性病变消退，新月体消失。在 5.5 年的随访中，患者的肌酐稳定在 2.0mg/dL（176.8μmol/L），但仍存在持续性蛋白尿。
