Back to Search
Start Over
Persistent subclinical rejection associated with nodular B-cell infiltrates in a renal transplant recipient
- Source :
- Clinical Transplantation. 22:53-57
- Publication Year :
- 2008
- Publisher :
- Wiley, 2008.
-
Abstract
- Recently, B-cell infiltrates in acute rejection grafts have attracted interest as an indicator of refractory rejection. Here, we report a case of deceased donor renal transplantation in a Japanese recipient operated overseas in which the recipient suffered from persistent tubulointerstitial rejection episodes associated with B-cell infiltrates. A 59-yr-old man with end-stage renal disease caused by immunoglobulin A nephropathy underwent deceased donor renal transplantation overseas in December 2005. The initial post-operative course was uneventful. The patient was referred to our hospital one month after transplantation. He maintained stable renal function throughout the follow-up period. The maintenance immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil and methylprednisolone. His serum creatinine concentration remained around 1.0 mg/dL, with no evidence of proteinuria. However, a discrepancy was detected between the renal function and the pathological findings. The pathology showed subclinical tubulointerstitial rejection with nodular B-cell infiltrates refractory to aggressive antirejection therapy. A steroid pulse and 15-deoxyspergualin were ineffective and the patient developed interstitial fibrosis and tubular atrophy by one yr after the transplantation, with persistent tubulitis and B-cell infiltrates. We treated the refractory rejection with B-cell infiltrates with a single 200 mg/body dose of rituximab and obtained an improvement. The pathological findings after administering rituximab consisted of mild tubulitis classified as Banff borderline, and elimination of the nodular B-cell infiltrates. At present, 20 months after renal transplantation, the patient continues to maintain stable renal function, with a good serum creatinine concentration (0.87 mg/dL).
- Subjects :
- Transplantation
medicine.medical_specialty
Kidney
Creatinine
business.industry
Urinary system
Renal function
Asymptomatic
Gastroenterology
Tacrolimus
Surgery
chemistry.chemical_compound
medicine.anatomical_structure
chemistry
Internal medicine
medicine
Rituximab
medicine.symptom
business
medicine.drug
Subjects
Details
- ISSN :
- 09020063
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Clinical Transplantation
- Accession number :
- edsair.doi...........bc69985ff5c8d0c154ca146dfe4e1c58