Acute graft loss secondary to necrotizing vasculitis. Evidence for cytokine-mediated Shwartzman reaction in clinical kidney transplantation.
A small number of kidney transplant recipients abruptly lose function secondary to acute renal artery or vein thrombosis or more rarely a form of necrotizing vasculitis. We report a group of four kidney transplant recipients who lost renal function and share the following features: (1) diabetes (type I, insulin-dependent diabetes mellitus, type II or steroid-induced); (2) abrupt change/loss of renal function; (3) a concomitant clinical event (fever, viral symptoms, menometrorrhagia, viremia, bacteremia); (4) severe necrotizing vasculitis with hemorrhagic necrosis on histopathology; (5) patent renal artery and vein at time of transplant nephrectomy (i.e., no vascular thrombosis); and (6) high levels of peripheral serum gamma-IFN 1-5 days before transplant nephrectomy (467 +/- 175 pg/ml) compared with that of patients experiencing severe rejection (8.4 +/- 3.7 pg/ml) (P < 0.002). These data support the concept of a cytokine (IFN-gamma)-mediated accelerated inflammatory response resulting in graft loss from necrotizing vasculitis--the clinical equivalent of an organ-specific Shwartzman reaction.
Burke
G W
GW
University of Miami School of Medicine, Department of Surgery, Florida, USA.
Cirocco
R
R
Markou
M
M
Viciana
A
A
Ruiz
P
P
Allouch
M
M
Esquenazi
V
V
Roth
D
D
Nery
J
J
Miller
J
J
D000328:Adult; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D003928:Diabetic Nephropathies / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D014657:Vasculitis / Q000473:pathology* / Q000503:physiopathology
D015415:Biomarkers; D016207:Cytokines