PDF(Pubmed)
Abstract：
Excessive immunosuppression after kidney transplantation (KT) is often encountered in patients undergoing therapy for anti-rejection or autoimmune disease that requires further treatment using immunosuppressive medications (IMs), including biologic agents. We report a novel case wherein a kidney transplant recipient developed severe acute allograft injury and hemorrhagic cystitis at 4.5 years after KT due to adenovirus nephritis after treatment with infliximab for Crohn\'s disease. The diagnosis was made based on adenovirus immunohistochemistry staining and urine polymerase chain reaction tests. The patient was successfully treated by reducing IMs and administration of immunoglobulin even though allograft function was eventually partially recovered. When new immunosuppressive agents, particularly biologic agents, are initiated for other diseases in addition to maintenance IMs, the following points need to be regarded: (1) pay attention to opportunistic infections even in the late phase of KT, and (2) maintain communication with other specialists who prescribe biologics to ensure appropriate administration of IMs.
摘要：
在接受抗排斥或自身免疫性疾病治疗的患者中，经常会遇到肾移植后过度免疫抑制（KT），需要使用免疫抑制药物（IM）进行进一步治疗。包括生物制剂。我们报告了一个新的病例，其中肾移植受者在KT后4.5年因腺病毒肾炎在英夫利昔单抗治疗克罗恩病之后发展为严重的急性同种异体移植损伤和出血性膀胱炎。根据腺病毒免疫组织化学染色和尿聚合酶链反应试验进行诊断。即使同种异体移植物功能最终部分恢复，患者仍通过减少IM和施用免疫球蛋白成功治疗。当新的免疫抑制剂，特别是生物制剂，除维护IM外，还针对其他疾病启动，需要注意以下几点:(1)即使在KT晚期也要注意机会性感染,（2）与开处方生物制剂的其他专家保持沟通，以确保对IM进行适当的管理。
