title: Serious duodenitis concomitant with graft dysfunction following renal transplantation.
abstract: A 48-year-old woman underwent a renal transplantation from her sister. The graft functioned immediately. She received induction immunosuppressive therapy, including basiliximab, tacrolimus hydrate, mycophenolate mofetil and methylprednisolone. Her urinary output decreased on the first postoperative morning. Plasma exchange for 3 days and conversion from tacrolimus hydrate to cyclosporine partially improved graft function. Graft biopsies on the fifth postoperative day suggested an acute humoral rejection. On the seventh postoperative day, she experienced high fever, disorientation, hypertension and severe upper abdominal pain with a bulk of bloody stool. Graft function deteriorated again. Gastrointestinal fibroscopy showed severe duodenitis with bleeding. Following seven successive daily plasma exchanges with hemodialysis and reconversion to low dose tacrolimus hydrate, the systematic symptoms and graft function gradually improved. Two years after transplantation, graft function was good with a serum creatinine level of 1.0 mg/dL. The patient did not experience any further gastrointestinal symptoms.
authors.affiliation: Department of Urology and Kidney Transplantation, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama City 232-0024, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Saito
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamagishi
authors.forename: Junichi
authors.initials: J
authors.lastname: Teranishi
authors.forename: Kazumi
authors.initials: K
authors.lastname: Noguchi
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Makiyama
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kubota
mesh_terms: D004382:Duodenitis / Q000150:complications* / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000150:complications* / Q000628:therapy; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index