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KMID : 0359920060250050863
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Korean Journal of Nephrology
2006 Volume.25 No. 5 p.863 ~ p.869
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A Case Report of Successful Treatment with Plasmapheresis and Intravenous Immunoglobulin in a Renal Transplant Recipient with Acute Humoral Rejection
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Lee Jeong-Hwan
Cha Ran-Hui
Kim Chi-Weon
Kim Sun-Moon
Jang Hye-Ryoun
Ha Jong-Won
Park Myoung-Hee
Moon Kyung-Chul
Kim Yon-Su
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Abstract
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Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection. Korean J Nephrol 2006;25(5):863-869)
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KEYWORD
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Acute humoral rejection, Kidney transplanstation, Plasmapheresis, Intravenous immunoglobulin
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