PDF(Pubmed)
Abstract：
BACKGROUND: Anti-angiotensin II type 1 receptor antibodies (AT1R-Abs) have been demonstrated to increase the risk of antibody-mediated rejection. We report a case of AT1R-Ab mediated rejection which caused early critical cortical infarction.
METHODS: A 52-year-old man with end-stage kidney disease underwent preemptive kidney transplantation (KT) from his wife. He had no immunologic risk except ABO incompatibility. Proper desensitization treatment were applied prior to KT. On postoperative day 1, he showed stable clinical course with adequate urine output, but there was no decrease in serum creatinine level and imaging studies showed hypoperfusion in the transplanted kidney.
METHODS: Allograft biopsy revealed total cortical infarction with severe necrotizing vasculitis, but the medullary area was preserved. Serum AT1R-Ab concentration was elevated from 10.9 U/mL before KT to 19.1 U/mL on 7 days after KT.
METHODS: He was treated with plasmapheresis, intravenous immunoglobulin, rituximab, high-dose methylprednisolone, and bortezomib.
RESULTS: The treatment showed a partial response, and he was discharged with 7.3 mg/dL creatinine level. At 4 months, his creatinine plateaued at 5.5 mg/dL and AT1R-Ab decreased to 3.6 U/mL.
CONCLUSIONS: This case highlights the risk of early active antibody-mediated rejection by preformed AT1R-Ab, suggesting its ability to exhibit atypical histopathologic findings, such as total cortical infarction.
METHODS: A 52-year-old man with end-stage kidney disease underwent preemptive kidney transplantation (KT) from his wife. He had no immunologic risk except ABO incompatibility. Proper desensitization treatment were applied prior to KT. On postoperative day 1, he showed stable clinical course with adequate urine output, but there was no decrease in serum creatinine level and imaging studies showed hypoperfusion in the transplanted kidney.
METHODS: Allograft biopsy revealed total cortical infarction with severe necrotizing vasculitis, but the medullary area was preserved. Serum AT1R-Ab concentration was elevated from 10.9 U/mL before KT to 19.1 U/mL on 7 days after KT.
METHODS: He was treated with plasmapheresis, intravenous immunoglobulin, rituximab, high-dose methylprednisolone, and bortezomib.
RESULTS: The treatment showed a partial response, and he was discharged with 7.3 mg/dL creatinine level. At 4 months, his creatinine plateaued at 5.5 mg/dL and AT1R-Ab decreased to 3.6 U/mL.
CONCLUSIONS: This case highlights the risk of early active antibody-mediated rejection by preformed AT1R-Ab, suggesting its ability to exhibit atypical histopathologic findings, such as total cortical infarction.
摘要：
背景：已证明抗血管紧张素II1型受体抗体（AT1R-Abs）会增加抗体介导的排斥反应的风险。我们报告了一例AT1R-Ab介导的排斥反应，导致早期严重的皮质梗塞。
方法：一名52岁的终末期肾病患者接受了妻子的先发制人肾移植（KT）。除了ABO不相容外，他没有免疫风险。在KT之前应用适当的脱敏治疗。术后第1天，患者临床病程稳定，尿量充足，但血清肌酐水平没有下降,影像学检查显示移植肾灌注不足.
方法：同种异体移植活检显示全皮质梗死伴严重坏死性血管炎，但延髓区被保留了下来.血清AT1R-Ab浓度从KT前的10.9U/mL升高至KT后7天的19.1U/mL。
方法：患者接受血浆置换治疗，静脉注射免疫球蛋白，利妥昔单抗,大剂量甲基强的松龙，还有硼替佐米.
结果：治疗显示部分缓解，出院时肌酐水平为7.3mg/dL。4个月时,肌酐稳定在5.5mg/dL，AT1R-Ab降至3.6U/mL。
结论：该病例强调了预先形成的AT1R-Ab早期活性抗体介导的排斥反应的风险，表明其表现出非典型组织病理学发现的能力，如全皮质梗死。
方法：一名52岁的终末期肾病患者接受了妻子的先发制人肾移植（KT）。除了ABO不相容外，他没有免疫风险。在KT之前应用适当的脱敏治疗。术后第1天，患者临床病程稳定，尿量充足，但血清肌酐水平没有下降,影像学检查显示移植肾灌注不足.
方法：同种异体移植活检显示全皮质梗死伴严重坏死性血管炎，但延髓区被保留了下来.血清AT1R-Ab浓度从KT前的10.9U/mL升高至KT后7天的19.1U/mL。
方法：患者接受血浆置换治疗，静脉注射免疫球蛋白，利妥昔单抗,大剂量甲基强的松龙，还有硼替佐米.
结果：治疗显示部分缓解，出院时肌酐水平为7.3mg/dL。4个月时,肌酐稳定在5.5mg/dL，AT1R-Ab降至3.6U/mL。
结论：该病例强调了预先形成的AT1R-Ab早期活性抗体介导的排斥反应的风险，表明其表现出非典型组织病理学发现的能力，如全皮质梗死。
