Abbasi Ali B, Gamino Gerardo, Zambeli-Ljepović Alan, Whelan Adrian M, Roll Garrett R, Altshuler Peter J
Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.
School of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Front Immunol. 2025 May 23;16:1605146. doi: 10.3389/fimmu.2025.1605146. eCollection 2025.
We report two cases of malakoplakia after kidney transplant, a rare granulomatous condition that occurs primarily in immunocompromised patients and his thought to occur due to incomplete clearance of phagocytized bacterial residue by macrophages. Both patients were at heightened immunological risk due to being highly sensitized or prior episodes of rejection, both experienced infections in the first 4 months after transplant, and both presented with granulomatous masses that were biopsied and confirmed to be malakoplakia. Both were treated with suppressive antibiotics and required urinary drainage of the transplant kidney, resulting in improvements in the size of the mass on imaging. Given that both patients were at heightened immunological risk due to sensitization or episodes of rejection, we sought to investigate whether these are common risk factors for malakoplakia in the published literature. We summarized 59 published reports of malakoplakia in kidney transplant recipients. We found that malakoplakia cases predominantly occur in the first two years after transplant and that 47% of patients had either prior rejection or a prior transplant. We also found that many case reports of malakoplakia involve infections and that improvement or resolution of malakoplakia was more common in case reports that did not involve surgical resection of the mass.
我们报告了两例肾移植后发生软斑病的病例，软斑病是一种罕见的肉芽肿性疾病，主要发生在免疫功能低下的患者中，被认为是由于巨噬细胞对吞噬的细菌残渣清除不完全所致。两名患者因高度致敏或既往有排斥反应发作而处于较高的免疫风险中，两人在移植后的前4个月均发生感染，且均出现肉芽肿性肿块，经活检确诊为软斑病。两人均接受了抑制性抗生素治疗，并需要对移植肾进行尿液引流，影像学检查显示肿块大小有所改善。鉴于两名患者因致敏或排斥反应发作而处于较高的免疫风险中，我们试图在已发表的文献中研究这些是否是软斑病的常见风险因素。我们总结了59篇关于肾移植受者软斑病的已发表报告。我们发现软斑病病例主要发生在移植后的头两年，47%的患者既往有排斥反应或既往有移植史。我们还发现，许多软斑病病例报告涉及感染，在不涉及肿块手术切除的病例报告中，软斑病的改善或消退更为常见。
