一名女性肾移植受者在妊娠和分娩后因抗HLA-DQ抗体介导的排斥反应。

Antibody-mediated rejection due to anti-HLA-DQ antibody after pregnancy and delivery in a female kidney transplant recipient.

作者信息

Sagasaki Makoto, Nakada Yasuyuki, Yamamoto Izumi, Kawabe Mayuko, Yamakawa Takafumi, Katsumata Haruki, Mafune Aki, Katsuma Ai, Kobayashi Akimitsu, Koike Kentaro, Koike Yusuke, Miki Jun, Yamada Hiroki, Kimura Takahiro, Tanno Yudo, Ohkido Ichiro, Tsuboi Nobuo, Yamamoto Hiroyasu, Yokoo Takashi

机构信息

Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.

Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.

出版信息

Nephrology (Carlton). 2018 Jul;23 Suppl 2:81-84. doi: 10.1111/nep.13279.

DOI:10.1111/nep.13279

PMID:29968405

Abstract

Herein, we report a case of antibody-mediated rejection (ABMR) due to anti-HLA-DQ antibody after pregnancy and delivery in a female kidney transplant recipient. A 34-year-old female recipient was admitted at 2 years after delivery for an examination of an elevated serum creatinine (S-Cr) level. The patient had received a living kidney transplantation from her mother at 22 years of age, and her kidney graft function was almost stable. The episode biopsy showed peritubular capillaritis and transplant capillaropathy with C4d immunoreactivity in the peritubular capillaries. Additional examination revealed expression of a donor-specific antibody (DSA) against HLA-DQ5, leading to the diagnosis of chronic active ABMR. Intravenous immunoglobulin, plasma exchange, and rituximab were administered, and her S-Cr level was maintained stable. This case demonstrates a possible relationship between pregnancy/delivery and development of ABMR due to a de novo DSA in a female kidney transplant recipient.

摘要

在此，我们报告一例女性肾移植受者在妊娠和分娩后因抗HLA-DQ抗体介导的抗体介导性排斥反应（ABMR）。一名34岁的女性受者在分娩后2年因血清肌酐（S-Cr）水平升高入院检查。该患者22岁时接受了来自其母亲的活体肾移植，其肾移植功能基本稳定。此次活检显示肾小管周围毛细血管炎和移植性毛细血管病，肾小管周围毛细血管有C4d免疫反应性。进一步检查发现存在针对HLA-DQ5的供体特异性抗体（DSA），从而诊断为慢性活动性ABMR。给予静脉注射免疫球蛋白、血浆置换和利妥昔单抗治疗，其S-Cr水平保持稳定。该病例表明女性肾移植受者妊娠/分娩与因新发DSA导致的ABMR发生之间可能存在关联。