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Refrakter Akut Humoral Renal Allograft Rejeksiyonunun Tek Doz Rituximab ile Başarılı Tedavisi

Successful Treatment of Refractory Acute Humoral Allograft Rejection with Single Dose Rituximab

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2010
DOI: 
doi: 10.5262/tndt.2010.1002.73

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Acute humoral rejection (AHR) is a rare event; however it can potentially lead to graft loss in up 40% of cases after 1 year of transplantation. A number of features like re-transplantation, ABO incompatibility and positive lymphocyte cross-match portend a high risk for AHR. We performed a retransplantation to a 23-year-old female patient who had lost her fi rst allograft due to polyomavirus nephropathy. After the second transplantation, she developed AHR that was confi rmed by allograft biopsy. We instituted steroid pulses for three days, alternate-day thymoglobulin, plasmapheresis and intravenous immunoglobulin. Despite this therapy, renal function did not improve; therefore as a last resort we administered singledose rituximab. Later on the course her urine output increased and kidney function recovered. In conclusion, rituximab can be tried as a last line of therapy in refractory AHR episodes.
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Abstract (Original Language): 
Akut humoral rejeksiyon (AHR) nadir bir olaydır, ancak transplantasyondan 1 yıl sonrasında greft kayıplarının %40’ı kadarından sorumlu olabilir. Tekrarlayan transplantasyon, ABO kan grubu uyumsuzluğu ve pozitif lenfosit cross-match gibi bazı özellikler AHR için yüksek risk teşkil eder. İlk transplant böbreğini poliomavirüs enfeksiyonu nedeniyle kaybeden 23 yaşındaki kadın hastaya ikinci böbrek naklini yapıldı. Hastada nakil sonrası, böbrek biyopsisi ile konfi rme edilen AHR gelişti. Üç gün boyunca günlük pulse steroid, günaşırı timoglobulin ve plazmaferez uygulandı. Daha sonra IVIG verildi. Bu tedavilere rağmen böbrek fonksiyonları iyileşmedi. Son çare olarak hastaya tek doz rituximab uyguladık verildi. Hastanın idrar çıkışı ve fonksiyonları iyileşti. Sonuç olarak, refrakter AHR episodlarında rituximab son tedavi seçeneği olarak denenebilir.
FULL TEXT (PDF): 
PDF icon arastrmx_172977_19_pp_140-142.pdf
  • 2
140-142
  • Turkish

REFERENCES

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