Successful renal transplantation in a patient with large granular lymphocytic leukemia with natural killer cell proliferation.
A patient with advancing renal failure attributed to focal segmental glomerulosclerosis was found to have marked NK (CD56+) cell expansion and large granular lymphocytic leukemia. Subsequent living-related renal transplantation was accomplished with two early bouts of acute cellular rejection requiring therapy with methylprednisolone and monoclonal antibody OKT3. Chronic triple drug immunosuppressive therapy has substantially reduced the marked NK (CD56+) proliferation. The renal transplantation remains successful after 15 months despite persistent but reduced numbers of circulating NK cells, the potential role of which in the pathogenesis of the underlying nephropathy or the cellular rejection process remains speculative.
Sibal
J
J
Department of Nephrology, Cleveland Clinic Foundation, Ohio, USA.
Valenzuela
R
R
Tubbs
R
R
Hodge
E
E
Nally
J
J
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019002:CD56 Antigen / Q000276:immunology; D002455:Cell Division; D005434:Flow Cytometry; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications; D006084:Graft Rejection / Q000628:therapy; D006801:Humans; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D007694:Killer Cells, Natural / Q000276:immunology / Q000473:pathology*; D007945:Leukemia, Lymphoid / Q000150:complications* / Q000628:therapy; D008218:Lymphocytosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D016853:Muromonab-CD3 / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000209:etiology / Q000601:surgery*
D000893:Anti-Inflammatory Agents; D019002:CD56 Antigen; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D008775:Methylprednisolone