Yeo Min-Kyung, Ham Young Rok, Choi Song-Yi, Lee Yong-Moon, Park Moon Hyang, Suh Kwang-Sun
Department of Pathology, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
Iran J Kidney Dis. 2017 Jul;11(4):322-325.
Kidney transplantation for amyloidosis remains a contentious issue. Recurrence of amyloidosis is one of the risks of transplantation. Chronic active antibody-mediated rejection is an important cause of chronic allograft dysfunction. A 47-year-old woman underwent kidney transplantation due to renal AA amyloidosis with unknown etiology. Six years posttransplantation, a kidney biopsy showed AA amyloidosis with chronic active antibody-mediated rejection. Donor-specific antibody class II was positive. The patient underwent intravenous plasmapheresis and treatment with rituximab and colchicine. The relationship between recurrence of amyloidosis and rejection was not obvious. Clinical characteristics of kidney transplantation for AA amyloidosis were subjected to literature review and 315 cases were identified. The incidence of amyloidosis recurrence and acute and chronic rejection rates were 15%, 15%, and 8%, respectively. Five-year patient and graft survival rates were 77% and 82%, respectively. Clinical courses of kidney transplantation in AA amyloidosis were, thus, identified.
肾移植治疗淀粉样变性仍然是一个有争议的问题。淀粉样变性复发是移植的风险之一。慢性活动性抗体介导的排斥反应是慢性移植物功能障碍的重要原因。一名47岁女性因病因不明的肾AA淀粉样变性接受了肾移植。移植后六年，肾活检显示AA淀粉样变性伴慢性活动性抗体介导的排斥反应。供者特异性抗体II类阳性。该患者接受了静脉血浆置换以及利妥昔单抗和秋水仙碱治疗。淀粉样变性复发与排斥反应之间的关系不明显。对AA淀粉样变性肾移植的临床特征进行了文献综述，共纳入315例病例。淀粉样变性复发率、急性和慢性排斥率分别为15%、15%和8%。患者和移植物的五年生存率分别为77%和82%。由此确定了AA淀粉样变性肾移植的临床病程。
