title: 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.
abstract: 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.
authors.affiliation: Department of Transplantation Surgery, University Hospital, Uppsala, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Gannedahl
authors.forename: S
authors.initials: S
authors.lastname: Ohlman
authors.forename: U
authors.initials: U
authors.lastname: Persson
authors.forename: S
authors.initials: S
authors.lastname: Gudmundsson
authors.forename: E
authors.initials: E
authors.lastname: Larsson
authors.forename: G
authors.initials: G
authors.lastname: Tydén
authors.forename: T H
authors.initials: TH
authors.lastname: Tötterman
authors.forename: B
authors.initials: B
authors.lastname: Wikström
authors.forename: L
authors.initials: L
authors.lastname: Weiss
authors.forename: C G
authors.initials: CG
authors.lastname: Groth
mesh_terms: 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
chemical_list: D000906:Antibodies; D006146:Guanidines; D006680:HLA Antigens; D007166:Immunosuppressive Agents; C037258:gusperimus