A case of pregnancy-induced thrombotic thrombocytopenic purpura with a kidney allograft recipient.
A 32-yr-old female patient, who had been suffering from diffuse crescentic glomerulonephritis and a consequent end-stage renal disease, successfully underwent living-related ABO-incompatible kidney transplantation after a desensitization therapy including anti-CD20 monoclonal antibody. Forty-six months after the transplantation, the recipient became pregnant. At the 17th gestational week, the patient was admitted for the management of pregnancy-induced hypertension and aggressive deterioration of kidney graft function. At the 21st gestational week, the patient lost her kidney graft and was re-induced into regular hemodialysis. The patient was also suffering from progressive hemolytic anemia, thrombocytopenia, and neurologic symptoms with decreased activity of von Willebrand factor-cleaving protease, a disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13). From these findings and a kidney allograft biopsy, the patient was diagnosed as thrombotic thrombocytopenic purpura concurrent with acute T-cell-mediated rejection. The patient immediately underwent plasma exchange as well as steroid pulse therapy. Despite these treatments, thrombocytopenia and intrauterine growth retardation progressed. The patient underwent a caesarian section at the 24th gestational week. Consequently, her platelet count recovered drastically. However, the patient lost her neonate five d after giving a birth, and the patient's graft function had never recovered.
Iwami
Daiki
D
Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo 060-8604, Japan. iiidaiki@jcom.home.ne.jp
Harada
Hiroshi
H
Hotta
Kiyohiko
K
Miura
Masayoshi
M
Seki
Toshimori
T
Togashi
Masaki
M
Hirano
Tetsuo
T
D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016030:Kidney Transplantation; D019520:Living Donors; D010951:Plasma Exchange; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D020551:Pulse Therapy, Drug; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology* / Q000473:pathology; D006435:Renal Dialysis; D013601:T-Lymphocytes / Q000276:immunology; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D005938:Glucocorticoids