Acute cellular rejection occurring on the first day after living-related renal transplantation: a case report.
The patient was a 52-year-old man who received an ABO-compatible but non-identical living-related renal graft from his wife. The graft started to function immediately and the urine output rate was over 100 mL/h. However, this was gradually decreased within 12 h after transplantation. On day 2 post-transplant, the urine output almost stopped. A biopsy specimen revealed lymphocyte dominant cellular infiltration in the interstitium with mild tubulitis (according to Banff's schema grade Ia) and no C4d deposition in peritubular capillaries. Immunohistochemistry disclosed T-cell infiltration. The patient responded to a course of steroid pulse therapy (five days of 500 mg of methylprednisolone). The urine output gradually increased and the level of serum creatinine gradually decreased to 1.0 mg/dL. These clinical and histological findings strongly suggested acute cellular rejection. Acute cellular rejection occurring within 24 h post-transplant is extremely rare. In the present case acute cellular rejection occurred within the first day after living-related renal transplantation and was strongly suspected from histopathological findings in the allograft biopsy specimen.
Maruyama
Michihiro
M
Department of Surgery, Clinical Research Center, Chiba East National Hospital, Chiba, Japan. maruyama@cehpnet.com
Kenmochi
Takashi
T
Saigo
Kenichi
K
Akutsu
Naotake
N
Iwashita
Chikara
C
Ohtsuki
Kazunori
K
Kitamura
Hiroshi
H
Joh
Kensuke
K
D000017:ABO Blood-Group System / Q000276:immunology; D000208:Acute Disease; D001706:Biopsy; D033001:Directed Tissue Donation; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D020551:Pulse Therapy, Drug
D000017:ABO Blood-Group System; D011239:Prednisolone