scholarly journals A Case of Transplant Nephrectomy due to Chronic Graft Intolerance Syndrome

Nephron ◽  
2020 ◽  
pp. 1-6
Author(s):  
Masahiro Tomonari ◽  
Akimitsu Kobayashi ◽  
Izumi Yamamoto ◽  
Saeko Hatanaka ◽  
Mayuko Kawabe ◽  
...  
Keyword(s):  
Interstitial Fibrosis ◽  
Graft Loss ◽  
Lower Abdominal Pain ◽  
Pulse Therapy ◽  
Kidney Graft ◽  
Cortical Necrosis ◽  
Steroid Pulse ◽  
Reactive Protein ◽  
Transplant Nephrectomy ◽  
Transplant Glomerulopathy

We report a case of graft intolerance syndrome in which transplant nephrectomy was performed 11 years after kidney transplantation. A 46-year-old man was admitted to our hospital in February 2018 with a mild fever, left lower abdominal pain, and gross hematuria with enlargement of the transplanted kidney. Urinary tract infection was ruled out. Because the symptoms developed after the immunosuppressants had been stopped after kidney graft loss, graft intolerance syndrome was suspected. He had lost his graft in 2016 and had stopped all immunosuppressants since January of 2017. Immunosuppressive therapy was intensified, and steroid half-pulse therapy was added for 3 days. After the steroid pulse therapy, the C-reactive protein (CRP) decreased from 6.47 mg/dL to 0.76 mg/dL, but there was little improvement in the symptoms, and the CRP then increased to 4.44 mg/dL. Transplant nephrectomy was performed in March 2018. Postoperatively, the symptoms disappeared without the administration of immunosuppressants, and the CRP decreased. Pathologically, the resected kidney graft showed persistent active allograft rejection with severe endarteritis, transplant glomerulopathy, and diffuse interstitial fibrosis. Massive thrombi occluded the large arteries, and there was extensive hemorrhagic cortical necrosis. Transplant nephrectomy is uncommon in patients >6 months after transplantation. However, even if more time has passed since transplantation, as in this case, transplant nephrectomy may be a valid option in some cases of severe graft intolerance syndrome.

scholarly journals Transplant nephrectomy; pathological features of 124 consecutive cases in a single center study over 10 years

2019 ◽  
Vol 8 (3) ◽  
pp. 23-23
Author(s):  
Masaki Muramatsu ◽  
Yoji Hyodo ◽  
Abigail Lee ◽  
Atsushi Aikawa ◽  
Carmelo Puliatti ◽  
...  
Keyword(s):  
Interstitial Fibrosis ◽  
Graft Loss ◽  
Morphological Characteristics ◽  
Tubular Atrophy ◽  
Histological Changes ◽  
Single Center Study ◽  
Main Renal Artery ◽  
Transplant Nephrectomy ◽  
Transplant Glomerulopathy ◽  
Tubulointerstitial Inflammation

Background: Transplant nephrectomy (TN) is not commonly performed but it may be essential for several indications. Objectives: This study details an in-depth evaluation of the histological changes present in TN specimens. Patients and Methods: We identified 124 consecutive TN cases between 2004 and 2014. The indication for TN was divided into four groups: acute graft loss without significant blood flow (AGL group- 47 cases); suspected ongoing rejection or graft intolerance syndrome (Rej/GIS group44 cases); infection (INF group- 24 cases); and miscellaneous reasons (MIS group- 9 cases). We examined the histological changes, including the main renal artery (MRA), intrarenal arteries, the renal vein and the ureter. Results: In AGL group, most cases showed no tubulointerstitial inflammation, interstitial fibrosis and tubular atrophy, but 74.5% had necrosis. All cases in Rej/GIS group showed severe interstitial fibrosis and tubular atrophy, since 40.9% showed severe tubulointerstitial inflammation. Glomerulitis was observed in 52.3% and transplant glomerulopathy (TG) was detected in 75.0%. Arteritis of intrarenal arteries and the MRA were detected in 70.5% and 59.1%. In INF group, 66.7% had tubulitis and 79.2% had interstitial inflammation with lymphocytes, and severe interstitial fibrosis while, tubular atrophy were detected in 66.7%. TG was detected in 62.5%. In MIS group, the histological changes were minor. Conclusions: This study provides a detailed description of the morphological characteristics associated with various indications for TN. TN will occasionally reveal unexpected and significant findings that may require specific forms of treatment to manage the patient appropriately.

scholarly journals Kidney Transplant Graftectomy by Severe Mixed-Type Rejection with Acute and Chronic Active Vascular Lesions at Entire Levels of the Renal Vasculature

Nephron ◽  
2020 ◽  
pp. 1-6
Author(s):  
Naoto Matsumoto ◽  
Akimitsu Kobayashi ◽  
Izumi Yamamoto ◽  
Yudo Tanno ◽  
Yusuke Koike ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Mixed Type ◽  
Immunosuppressive Treatment ◽  
Graft Function ◽  
Pulse Therapy ◽  
Vascular Lesions ◽  
Kidney Graft ◽  
Medication Regimen ◽  
Renal Vasculature ◽  
Steroid Pulse

Vascular lesions related to allograft rejection have a big impact on graft survival. As such, investigation of these lesions is important to understand the pathophysiology of rejection and its management. We report a case of kidney transplant graftectomy by severe mixed-type rejection with acute and chronic active vascular lesions caused by non-adherence to immunosuppressive treatment. The patient presented is a 29-year-old male who received a kidney transplantation in July 2011 (ABO compatible) from his father. He then did not come to the hospital for 3 months prior to his admission and also made his own decision to stop his medication regimen. On October 2013, the patient came to the hospital with dyspnea, nausea, and vomiting and had significant renal dysfunction (serum Cr 30.4 mg/dL, BUN 191 mg/dL). A kidney graft biopsy showed cortical necrosis with severe interstitial hemorrhage and thrombotic microangiopathy (TMA). Despite steroid pulse therapy, kidney graft function did not recover, and the patient underwent a subsequent graft resection. The resected kidney graft displayed various vascular lesions from the renal artery to the interlobular arteries and arterioles including endarteritis, TMA, fibrinoid necrosis, and transplant arteriopathy. This case shows the detailed pathological findings of the vascular lesions in the entire artery tree of kidney allograft, and the pathophysiology is discussed.

Abstract 120: A Case With Left Ventricular Failure And Unconsciousness Treated With Plasma Exchange

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Yuriko Abe ◽  
Mamoru Ayusawa ◽  
Masataka Kato ◽  
Ami Cho ◽  
Hirohumi Watanabe ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
White Blood Cells ◽  
Cervical Lymphadenopathy ◽  
Pulse Therapy ◽  
Left Ventricular ◽  
Lv Function ◽  
C Reactive Protein ◽  
Steroid Pulse ◽  
Reactive Protein ◽  
Electroencephalogram Eeg

Background: Either encephalopathy or left ventricular (LV) failure complicated with Kawasaki disease (KD) is rare but occasionally fatal. We experienced a critical case simultaneously complicated with both of them and successfully rescued by plasma exchange (PE). Case report: A 4-year-old girl was hospitalized with a high fever lasting 7 days, conjunctival injection, reddened and swollen lips, cervical lymphadenopathy and erythema of the palms and soles. Laboratory tests revealed that her white blood cells count 35,400/μl, C-reactive protein was 35 mg/dl, N-terminal pro-brain natriuretic peptide was 15,317 pg/ml, and interleukin-6 reported afterward was 354 pg/ml. Echocardiography showed that LV ejection fraction was 40%. She was diagnosed as KD and was treated with 2g/kg of intravenous immunoglobulin (IVIG) and oral aspirin on the 7th day of illness. On the following day, however, her blood pressure declined to 80/40mmHg and LV function was becoming gradually poorer despite of intravenous injection of dobutamine. As her consciousness was unclear and electroencephalogram (EEG) indicated slow waves, she was additionally treated with D-mannitol. Infliximab is not indicated because of heart failure. Therefore, repetitive PE was started immediately after deep sedation with mechanical respiratory assist. Her fever, EEG and LV function began improving by PE consecutive 3 days, however, those findings recurrently worsened at every interval of PE. IVIG and steroid pulse therapy were added on the 12th day after PE. On the 13th day, she became defervescent and her consciousness became clear and EEG normalized. She returned to daily life without cardiac or neurologic abnormalities after discharge. Conclusions: PE is a rapid and sufficiently effective strategy for a critical KD case when infliximab is not indicated or immediate effectiveness of steroid including pulse therapy is not expected.

scholarly journals Early Graft Loss after Kidney Transplantation: Endothelial Dysfunction of Renal Microvasculature

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
N. Kojc ◽  
M. Perše ◽  
J. Pleško ◽  
Ž. Večerić-Haler
Keyword(s):  
Electron Microscopy ◽  
Endothelial Dysfunction ◽  
Interstitial Fibrosis ◽  
Graft Loss ◽  
Prognostic Significance ◽  
Histological Evaluation ◽  
Kidney Graft ◽  
Donor Kidney ◽  
Tubular Atrophy ◽  
Renal Microvasculature

Decision process about the acceptance of the deceased donor kidney for transplantation might be challenging. Although histological evaluation of pretransplant donor kidney biopsy provides reliable information regarding cortical necrosis, vascular thrombosis, extensive global glomerulosclerosis, and interstitial fibrosis/tubular atrophy, only electron microscopy enables thorough and reliable insights into microvasculature changes of kidney graft. The aim of the present paper is to briefly present two cases of early kidney graft loss. In one case, the donor was exposed to long-term extracorporeal membrane oxygenation (ECMO); in the other case, the donor experienced Takotsubo cardiomyopathy. In both cases, light microscopy of pretransplant biopsy found no pathology or significant discrepancy in morphology of kidney graft, while electron microscopy revealed severe endothelial dysfunction of renal microvasculature. Our results suggest that severe injury of renal microvasculature with relatively preserved tubular epithelium may be associated with some conditions of deceased kidney donors leading to early kidney graft nonfunction and loss. Further studies are needed to determine prognostic significance of severe ultrastructural microvasculature lesions and to evaluate disease states and conditions that could be associated with severe endothelial dysfunction of kidney graft.

scholarly journals Vogt–Koyanagi–Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ryo Kikuchi ◽  
Tatsukata Kawagoe ◽  
Kazuki Hotta
Keyword(s):  
Case Report ◽  
Pulse Therapy ◽  
Steroid Pulse Therapy ◽  
Steroid Pulse

scholarly journals Eosinophilic Granulomatosis with Polyangiitis Presenting with Myocarditis as an Initial Symptom: A Case Report and Review of the Literature

2021 ◽  
pp. 329-333
Author(s):  
Kanako Kurihara ◽  
Jun Tsugawa ◽  
Shinji Ouma ◽  
Toshiyasu Ogata ◽  
Mikiko Aoki ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Nerve Biopsy ◽  
Pulse Therapy ◽  
Sural Nerve Biopsy ◽  
Lower Limbs ◽  
Rapid Progression ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Initial Symptom ◽  
Steroid Pulse ◽  
Eosinophilic Granulomatosis

A 66-year-old woman with a history of bronchial asthma had shortness of breath and fatigue upon mild exercise. She was diagnosed as congestive heart failure. A blood test showed eosinophilia without the presence of anti-neutrophil cytoplasmic antibody (ANCA), and a myocardial biopsy specimen revealed eosinophilic infiltration in the myocardium. Eosinophilia was improved when she was administered short-term methylprednisolone. After that, she had numbness and pain in her lower limbs with re-elevation of eosinophils. She had dysesthesia and hypalgesia in the distal part of the limbs. Sural nerve biopsy revealed axonal degeneration and thickness of the arterial wall, indicating a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA). Two courses of steroid pulse therapy were performed, resulting in marked improvement of her sensory symptoms. ANCA-negative EGPA might be associated with myocarditis and peripheral neuropathy. A sufficient immunotherapy should have been considered to prevent rapid progression.

scholarly journals A Kidney Transplant Recipient with Recurrent Henoch-Schönlein Purpura Nephritis Successfully Treated with Steroid Pulse Therapy and Epipharyngeal Abrasive Therapy

Nephron ◽  
2020 ◽  
pp. 1-5
Author(s):  
Mika Fujimoto ◽  
Kan Katayama ◽  
Kouhei Nishikawa ◽  
Shoko Mizoguchi ◽  
Keiko Oda ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Pulse Therapy ◽  
Steroid Pulse Therapy ◽  
Steroid Pulse ◽  
Schonlein Purpura ◽  
Purpura Nephritis

There is no specific treatment for recurrent Henoch-Schönlein purpura nephritis (HSPN) in a transplanted kidney. We herein report a case of a kidney transplant recipient with recurrent HSPN that was successfully treated with steroid pulse therapy and epipharyngeal abrasive therapy (EAT). A 39-year-old Japanese man developed HSPN 4 years ago and had to start hemodialysis after 2 months despite receiving steroid pulse therapy followed by oral prednisolone, plasma exchange therapy, and cyclophosphamide pulse therapy. He had undergone tonsillectomy 3 years earlier in the hopes of achieving a better outcome of a planned kidney transplantation and received a living-donor kidney transplantation from his mother 1 year earlier. Although there were no abnormalities in the renal function or urinalysis 2 months after transplantation, a routine kidney allograft biopsy revealed evidence of mesangial proliferation and cellular crescent formation. Mesangial deposition for IgA and C3 was noted, and he was diagnosed with recurrent HSPN histologically. Since the renal function and urinalysis findings deteriorated 5 months after transplantation, 2 courses of steroid pulse therapy were performed but were ineffective. EAT using 0.5% zinc chloride solution once per day was combined with the third course of steroid pulse therapy, as there were signs of chronic epipharyngitis. His renal function recovered 3 months after daily EAT and has been stable for 1.5 years since transplantation. Daily EAT continued for >3 months might be a suitable strategy for treating recurrent HSPN in cases of kidney transplantation.

scholarly journals Impact of Early Pancreatic Graft Loss on Outcome after Simultaneous Pancreas–Kidney Transplantation (SPKT)—A Landmark Analysis

2021 ◽  
Vol 10 (15) ◽  
pp. 3237
Author(s):  
Lukas Johannes Lehner ◽  
Robert Öllinger ◽  
Brigitta Globke ◽  
Marcel G. Naik ◽  
Klemens Budde ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Loss ◽  
Type I ◽  
Kidney Graft ◽  
Landmark Analysis ◽  
Pancreas Kidney Transplantation ◽  
Simultaneous Pancreas Kidney ◽  
Simultaneous Pancreas Kidney Transplantation ◽  
Pancreas Graft

(1) Background: Simultaneous pancreas–kidney transplantation (SPKT) is a standard therapeutic option for patients with diabetes mellitus type I and kidney failure. Early pancreas allograft failure is a complication potentially associated with worse outcomes. (2) Methods: We performed a landmark analysis to assess the impact of early pancreas graft loss within 3 months on mortality and kidney graft survival over 10 years. This retrospective single-center study included 114 adult patients who underwent an SPKT between 2005 and 2018. (3) Results: Pancreas graft survival rate was 85.1% at 3 months. The main causes of early pancreas graft loss were thrombosis (6.1%), necrosis (2.6%), and pancreatitis (2.6%). Early pancreas graft loss was not associated with reduced patient survival (p = 0.168) or major adverse cerebral or cardiovascular events over 10 years (p = 0.741) compared to patients with functioning pancreas, after 3 months. Moreover, kidney graft function (p = 0.494) and survival (p = 0.461) were not significantly influenced by early pancreas graft loss. (4) Conclusion: In this study, using the landmark analysis technique, early pancreas graft loss within 3 months did not significantly impact patient or kidney graft survival over 10 years.

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