Rejection associated with early appearance of donor-reactive antibodies after kidney transplantation treated with plasmapheresis and administration of 15-deoxyspergualin. A report of two cases.
In two kidney transplant patients, one of whom had panel-reactive antibodies (PRA) before transplantation, a pretransplant negative donor-recipient crossmatch became positive within the 1st week after transplantation. Simultaneously, good graft function deteriorated to a state of anuria. One patient graft biopsy showed a vascular rejection, whilst the other patient biopsy was unrevealing. Both patients were treated with plasmapheresis and a new immunosuppressive drug, 15-deoxyspergualin (DSG). Plasmapheresis was performed for 6 and 9 days, respectively, and DSG was given for 5 days in a dosage of 6 mg/kg body weight per day. One of the patients received methylprednisolone i.v. in addition. During treatment the cross-match became negative and has since remained that way. In both patients the graft function was restored. No adverse effects were seen from the treatment, except for a slight leukocytopenia and thrombocytopenia.
Gannedahl
G
G
Department of Transplantation Surgery, University Hospital, Uppsala, Sweden.
Ohlman
S
S
Persson
U
U
Gudmundsson
S
S
Larsson
E
E
Tydén
G
G
Tötterman
T H
TH
Wikström
B
B
Weiss
L
L
Groth
C G
CG
D000328:Adult; D000906:Antibodies / Q000032:analysis*; D005260:Female; D006084:Graft Rejection; D006146:Guanidines / Q000627:therapeutic use*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D010956:Plasmapheresis
D000906:Antibodies; D006146:Guanidines; D006680:HLA Antigens; D007166:Immunosuppressive Agents; C037258:gusperimus