A case of Castleman disease that improved after kidney transplantation / 대한이식학회지

This is a case of a 56-year-old man with Castleman disease (CD) who improved after kidney transplantation (KTP). CD is an uncommon lymphoproliferative disorder that was found incidentally on biopsy during dialysis in the current patient and was followed up without further treatment. However, the lesion showed improvement after KTP. Therefore, active KTP can be considered even if CD is one of the lymphoproliferative disorders that can occur as a complication after KTP.

De Novo AL Amyloidosis in a Renal Allograft / 대한내과학회지

Amyloidosis is characterized by the extracellular deposition of amyloid in various tissues and organs, particularly the kidney and heart. The estimated incidence of systemic amyloidosis is at least 8 per million population per year. However, few cases of systemic amyloidosis in renal allografts have been reported. A stable renal transplant recipient was admitted with proteinuria and dyspnea on exertion. The M-peak was found on serum and urine protein electrophoresis, and lambda (λ) dominance was confirmed by serum and urine free-light-chain test. The patient was diagnosed with systemic amyloidosis of a renal allograft, by allograft biopsy, at 22 years after renal transplantation. We report a case of AL amyloidosis in a stable renal allograft and review the medical literature.

Cutaneous and Systemic Plasmacytosis Associated with Renal Amyloidosis

Cutaneous and systemic plasmacytosis (CSP) is a rare disorder of unknown etiology characterized by cutaneous polyclonal plasma cell infiltrates associated with various extracutaneous involvement and polyclonal hypergammaglobulinemia. Here, we report on a 54-year-old male patient with chronic renal insufficiency who presented with disseminated reddish-brown macules and plaques on the face and trunk. In our evaluation, he was found to have lymphadenopathy, polyclonal hypergammaglobulinemia; benign plasma cell infiltration involving the skin, bone marrow, and retroperitoneal area; and renal amyloidosis. To the best of our knowledge, this is the first reported case of CSP associated with renal amyloidosis.

A Single Center Experience of ABO Incompatible Kidney Transplantation / 대한이식학회지

BACKGROUND: Kidney transplantation (KT) is the optimal treatment for end stage renal disease. However, the relative shortage of organs for transplantation (from human leukocyte antigen- or ABO incompatible [ABOi] living donors) has led to ABOi KT as an accepted method to expand the pool of living kidney donors. To date, reports of the outcomes of ABOi KT are limited; therefore this study aims to evaluate the outcomes of ABOi KT in recipients. METHODS: We identified 45 patients who underwent live-donor ABOi KT between February 2007 and November 2011 at Maryknoll Medical Center. All of them were treated according to the scheduled protocol of plasmapheresis with low dose intravenous immunoglobulin, and low dose rituximab- or tacrolimus-based triple immunosuppressant regimens. Clinical parameters and the incidence of rejections in these patients were analyzed. RESULTS: We had three cases (6.6%) of biopsy-proven acute antibody-mediated rejections and one case (2.2%) of acute cellular rejection, all of which were successfully treated. The median follow-up duration was 20 months (range, 2~59). Antibody depletion was scheduled according to baseline anti-ABO antibody titer (tube method: median immunoglobulin G titer/immunoglobulin M titer 64 [range, 8~4,096]/16 [range, 2~256], respectively). Although there was no patient death, one patient lost his graft due to nonadherence to immunosuppressants. CONCLUSIONS: Our analysis of ABOi KT has shown excellent and promising outcomes. These practices may therefore represent an acceptable option for expanding the pool of living kidney donors.

A case of acute renal failure caused by extrinsic compression of the left renal artery in lymphoma / 대한내과학회지

Malignant lymphomas can involve any organ, but rarely cause acute renal failure as an initial manifestation. Impaired renal function secondary to renal arterial compression by a tumor mass has not been reported. A 50-year-old man was admitted with low back pain, weight loss, and a palpable abdominal mass. He developed non-oliguric acute renal failure secondary to extrinsic compression of the left renal artery by enlarged lymph nodes in the posterior wall of the pelvic cavity. Abdominal computed tomography (CT) showed the complete absence of perfusion of the left kidney due to extrinsic compression of the left renal artery by a huge diffuse large B cell lymphoma (stage IVa, International Prognostic Index score 3). We report a case of malignant lymphoma presenting as acute renal failure due to extrinsic compression of the left renal artery; this was treated successfully with systemic combination chemotherapy

Immune hemolytic anemia secondary to ABO minor incompatibility in renal recipients / 대한내과학회지

BACKGROUND: Immune hemolysis secondary to ABO minor incompatibility is a rare graft versus host disease in renal recipients, secondary to anti-ABO antibody produced by lymphocytes of donor origin that reacts against recipient RBCs. METHODS: To investigate the incidence and clinical features of immune hemolysis secondary to ABO minor incompatibility in renal allograft recipients, clinical records of 358 renal transplantation performed in Maryknoll Hospital since 1991 were analyzed retrospectively. RESULTS: Fifty four (15%) of 358 renal transplants were ABO minor incompatible. Immune hemolysis secondary to anti-ABO antibody developed in 5 (9.2%) of 54 ABO minor incompatible renal transplant recipients. Immune hemolysis occurred in 3 (13.6%) patients among 22 allografts from blood type O donor to A recipients and 2 (10%) patients among 20 from blood type O donor to B recipients. All 5 patients received cyclosporin with prednisolone, and MMF was administered to one patient additionally. Immune hemolysis developed on 14+/-3 days after renal transplantation and lasted for about 10+/-3 days. The maximum reduction of hemoglobin was 3.3+/-1.0 g/dL. All patients required donor type (blood type O) washed RBCs transfusion (5.0+/-2.6 units per patient) and plasmapheresis were performed in 3 patients (4.0+/-1.0 per patient). All patients recovered without deterioration of graft function. Age, number of HLA mismatch, creatinine at 1 year after transplantation, frequency of acute rejection and serum cyclosporin level during first 2 weeks were not significantly different between hemolysis group (N=5) and non-hemolysis group (N=49). Living unrelated transplantation is associated with increased incidence of immune hemolysis compared with living related transplantation (p<0.01). CONCLUSION: Although immune hemolysis secondary to ABO minor incompatibility is uncommon, we experienced cases with marked reduction of hemoglobin that required a large amount of transfusion. Therefore, this type of immune hemolysis needs to be considered as a differential diagnosis of posttransplant hemolysis. As our center routinely performs donor specific transfusion (DST), the incidence may be higher than that of other centers where DST is not usually given.