Immune-mediated hemolytic anemia in pediatric renal transplantation.
The aim of the study was to demonstrate clinical course of the first reported cases of PLS in pediatric kidney transplantation and therapeutic outcome for such condition using a combination of high-dose corticosteroid and tacrolimus. We report a single case (a nine-year-old Thai boy) with end-stage kidney disease secondary to obstructive uropathy developed immune-mediated hemolytic anemia from the PLS at second week after a pre-emptive living-related kidney transplantation. The alloimmune hemolysis was a result of anti-B antibodies, derived from blood group O-donor lymphocytes. Using a combination of high-dose corticosteroid and a substitution of cyclosporin with tacrolimus, there was no further hemolysis although the anti-B antibodies remained detectable until the eighth week post-transplantation. An impairment of the graft function because of hemoglobinuria was resolved after the hemolysis was stopped. The alloimmune hemolysis caused by PLS in pediatric kidney transplantation could be controlled with a combination of high-dose corticosteroid and tacrolimus.
Pattaragarn
Anirut
A
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siapt@mahidol.ac.th
Viprakasit
Vip
V
Supavekin
Suroj
S
Sumboonnanonda
Achra
A
D000743:Anemia, Hemolytic / Q000188:drug therapy* / Q000276:immunology*; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011239:Prednisolone / Q000008:administration & dosage*; D016559:Tacrolimus / Q000008:administration & dosage*
D005938:Glucocorticoids; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone