title: Immune-mediated hemolytic anemia in pediatric renal transplantation.
abstract: 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.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siapt@mahidol.ac.th
authors.forename: Anirut
authors.initials: A
authors.lastname: Pattaragarn
authors.forename: Vip
authors.initials: V
authors.lastname: Viprakasit
authors.forename: Suroj
authors.initials: S
authors.lastname: Supavekin
authors.forename: Achra
authors.initials: A
authors.lastname: Sumboonnanonda
mesh_terms: 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*
chemical_list: D005938:Glucocorticoids; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone