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Korean J Med > Volume 86(2); 2014 > Article
The Korean Journal of Medicine 2014;86(2): 237-241.
신 이식 후 항체 매개성 거부반응 환자에서 지연성 회복을 보인 치료 1예
조형진, 신은혜, 양영주, 정지원, 지원준, 최영권, 박수길
울산대학교 의과대학 서울아산병원 내과
A Case of Delayed Recovery from Antibody-Mediated Rejection
Hyung Jin Cho, Eun Hye Shin, Young Joo Yang, Ji Won Jung, Won Jun Ji, Young Kwon Choi, Su-Kil Park
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding Author: Su-Kil Park ,Tel: +82-2-3010-3263, Fax: +82-2-3010-8047, Email: skpark@amc.seoul.kr
Received: April 16, 2013;   Revised: July 15, 2013;   Accepted: August 12, 2013.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Antibody-mediated rejection (ABMR) in kidney transplant recipients is mediated by donor-specific antibodies. It is the major cause of graft failure in noncompliant patients and is associated with reduced long-term graft survival. We present a case of delayed recovery of renal function despite aggressive therapy after acute ABMR. A 49-year-old male on triple-drug maintenance immunosuppression (prednisolone, cyclosporine, and azathioprine), who underwent cadaveric donor renal transplantation 14 years earlier, visited our clinic with a serum creatinine level (SCr) of 1.9 mg/dL. The kidney biopsy revealed acute ABMR with diffuse C4d immunopositivity. We started steroid pulse therapy and bortezomib with plasmapheresis. Nevertheless, the SCr increased. Consequently, antithymocyte globulin (ATG) and intravenous immunoglobulin were administered. The SCr increased further to 4.1 mg/dL. Therefore, we performed a second kidney biopsy, which showed no change. Finally, we used rituximab. Fortunately, the SCr decreased gradually and returned to baseline. (Korean J Med 2014;86:237-241)
Keywords: Kidney transplantation; Graft rejection; Medication adherence
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