Successful renal transplantation in a patient with antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis: effect of early plasma exchange and mycophenolate mofetil.
Antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis readily relapses after renal transplantation; the recurrence often causes graft losts. We have reported herein a 53-year-old cadaveric renal allograft recipient. His original disease was ANCA-associated microscopic polyangiitis (MPA), which was proven by renal biopsy. On postoperative day 4, the patient developed dyspnea, hemoptysis, and gross hematuria; the serum p-ANCA titer increased from 1:40 to 1:80. The patient was immediately treated with 5 sessions of plasma exchange. Five days later, the hemoptysis and gross hematuria both disappeared. Serum p-ANCA titer recovered to 1:40. The patient showed stable graft function for 2 months, until mycophenolate mofetil (MMF) was converted to mizoribine (150 mg/d). Seven days after the conversion, the serum creatinine increased from 1.27 to 1.7 mg/dL. Serum p-ANCA increased to 1:160. When mizoribine was converted to MMF, 2 days later the renal function and p-ANCA titer recovered. This case report suggested that early use of plasma exchange combined with MMF was effective to prevent the relapse of ANCA-associated systemic vasculitis after transplantation, and may be helpful to improve transplant outcomes.
Sun
Q
Q
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China.
Cheng
D
D
Wen
J
J
Chen
J
J
Gong
D
D
Liu
Z
Z
Li
L
L
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D002102:Cadaver; D005921:Glomerulonephritis / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010951:Plasma Exchange; D014019:Tissue Donors; D014657:Vasculitis / Q000628:therapy*
D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D008775:Methylprednisolone