Successful rescue of late-onset acute T-cell mediated rejection with anti-CD25 antibody: a case report.
Japan A 56-yr-old Japanese male with a history of diabetic nephropathy underwent a HLA 5/6 mismatch and ABO-compatible living-related kidney transplantation (donor: his 49-yr-old wife). A pre-transplant standard NIH complement-dependent cytotoxicity cross-match (Xm) test, a flow-cytometric T-cell Xm, and a FlowPRA test were totally negative. Inductionimmunosuppressive protocol consisted of tacrolimus, mycophenolate mofetil, methylprednisolone, and basiliximab (BAS). The patient's post-operative course was almost uneventful, and the graft was functioning well (sCr 1.1 mg/dL). He developed general fatigue, and his sCr was elevated to 2.2 mg/dL 792 d after transplant. A graft biopsy showed acute T-cell mediated rejection Banff grade IB (i3, t3, g0, v0, ptc0, C4d staining negative). The conventional anti-rejection therapy could not improve his graft function; therefore, we added BAS to eliminate activated graft-infiltrating T-cells. He responded to the rescue therapy, and the improvement in graft function was confirmed by a subsequent graft biopsy. He enjoyed his health without any opportunistic infections.
Osawa
Takahiro
T
Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan. taka0573@gmail.com
Harada
Hiroshi
H
Miura
Masayoshi
M
Ogawa
Yayoi
Y
Morooka
Kanako
K
Nakamura
Michiko
M
Tanabe
Tatsu
T
Takada
Norikata
N
Seki
Toshimori
T
Togashi
Masaki
M
Takenouchi
Toshinao
T
Hirano
Tetsuo
T
D000208:Acute Disease; D001706:Biopsy; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053645:Interleukin-2 Receptor alpha Subunit / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology*; D013997:Time Factors
D007166:Immunosuppressive Agents; D053645:Interleukin-2 Receptor alpha Subunit