A case of acute rejection with adenovirus infection after ABO-incompatible kidney transplantation.
We report clinical and histopathologic findings of a case of acute rejection with adenovirus infection after kidney transplantation. A 63-yr-old woman with end-stage renal disease caused by lupus nephritis received an ABO-incompatible living kidney transplantation from her husband. On the 7th post-operative day (POD), she had fever, hematuria, and bladder irritation. Although she was treated with an antibiotic, the symptoms were not improved. We diagnosed adenovirus infection as positive with the urine shell vial method and blood PCR analysis. Cyclophosphamide was interrupted and immunoglobulin therapy was performed. However, urine output decreased and serum creatinine levels increased. An episode biopsy was performed on POD 20. We diagnosed acute antibody-mediated rejection. She was treated with plasma exchange for acute rejection and antiviral drug (rivabirin) for active adenovirus infection. However, the renal graft dysfunction was deemed irreversible and the renal graft was removed on POD 34. The graftectomy specimen showed acute rejection and acute tubular necrosis with adenovirus infection.
Komiya
Toshiyuki
T
Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan. t-komiya@kitano-hp.or.jp
Goto
Norihiko
N
Takeda
Asami
A
Horike
Keiji
K
Onoda
Hiroshi
H
Sakai
Kaoru
K
Kitamura
Ken
K
Yamamoto
Keiko
K
Oikawa
Tadashi
T
Nagasaka
Takaharu
T
Hiramitsu
Takahisa
T
Simabukuro
Syuichi
S
Suzuki
Keisuke
K
Sato
Tetsuhiko
T
Yoshihiko
Watarai
W
Uchida
Kazuharu
K
Morozumi
Kunio
K
D000017:ABO Blood-Group System / Q000276:immunology*; D000208:Acute Disease; D000258:Adenovirus Infections, Human / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D000260:Adenoviruses, Human / Q000276:immunology*; D000914:Antibodies, Viral / Q000032:analysis; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology*; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008875:Middle Aged
D000017:ABO Blood-Group System; D000914:Antibodies, Viral