title: A case of progressive thrombotic microangiopathy after ABO-incompatible renal transplantation.
abstract: A 21-yr-old man of blood type O receiving hemodialysis for IgA nephropathy underwent living-related ABO-incompatible (ABOI) renal transplantation from his mother, whose blood type is A. He was negative for flow cross-match, anti-human leukocyte antigen (HLA) antibody, and anti-MICA antibody. Pre-treatment anti-A IgG titer was 1:256. Desensitization consisted of tacrolimus, mycophenolate mofetil, methylprednisolone, rituximab, and plasmapheresis. He developed acute antibody rejection at day 2 post-transplant, which was successfully treated. After renal artery reconstruction surgery at day 91 for renovascular hypertension caused by renal artery stricture, the patient suffered from acute prostatitis, which subsequently induced type III acute antibody-mediated rejection. Even after recovery from the rejection after temporary hemodialysis, graft function progressively deteriorated and consecutive allograft biopsy showed progressive thrombotic microangiopathy (TMA) without any evidence of donor-specific antibody other than anti-A antibody. The tacrolimus dose was kept low for fear of tacrolimus-induced TMA. Despite these efforts, the patient resumed hemodialysis six months' post-transplant.
authors.affiliation: Department of Renal Transplantation Surgery, Sapporo Hokuyu Hospital, Sapporo, Japan. uromasa@mac.com
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Miura
authors.forename: Hiromi
authors.initials: H
authors.lastname: Fujita
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Kanako C
authors.initials: KC
authors.lastname: Kubota
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Fukasawa
authors.forename: Naohiko
authors.initials: N
authors.lastname: Shimoda
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Tsuchihashi
authors.forename: Tohru
authors.initials: T
authors.lastname: Tamaki
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology*; D018450:Disease Progression; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007518:Isoantibodies / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis; D057049:Thrombotic Microangiopathies / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D007518:Isoantibodies