RESUMEN
Mycophenolate mofetil (MMF) is a immunosuppressive agent increasingly used in organ transplantation and autoimmune disease. We report a case about use of MMF in SLE patient with rapidly worsening renal function. A 24-year old female was admitted due to 1-week history of generalized edema. Despite use of diuretics and conventional supported care, generalized edema was more aggravated and serum creatinine was elevated up to 5.2 mg/dL. Ten days after the initial admission, we started hemodialysis. After hemodialysis, improvement of generalized edema was achieved. Eighteen days after initial hemodialysis, we started corticosteroids and MMF because she shows persistent heavy proteinuria and oliguria. After use of corticosteroids and MMF, clinical improvement of renal complication was achieved in this patient. About 6 weeks later, we could discontinue hemodialysis. On two year follow up duration, she shows good renal function and no evidence of lupus flare-up signs. We suggest MMF is one of therapeutic options for patients with severe lupus nephritis, especially those refractory or intolerant to conventional cytotoxic agents.
Asunto(s)
Femenino , Humanos , Adulto Joven , Lesión Renal Aguda , Corticoesteroides , Enfermedades Autoinmunes , Creatinina , Citotoxinas , Diuréticos , Edema , Estudios de Seguimiento , Nefritis Lúpica , Oliguria , Trasplante de Órganos , Proteinuria , Diálisis Renal , TrasplantesRESUMEN
BACKGROUND: Poor HLA matched donors may become an additional organ source for renal transplantation. This study is conducted to predict the clinical outcomes of renal transplantation in a poor HLA matched group (0 or 1 or 2 HLA matching) by comparing them with those of HLA haploidentical group. METHODS: This study compared a poor HLA matched group (N=89) with HLA haploidentical group (N=79) to analyze differences between two groups in graft survival, incidence of acute rejection, cause of graft failure, posttransplant serum creatinine at 1, 2, 3, 5 years. Total 168 cases, appeared in the medical records for more than six months in Bong-Saeng Hospital, from December, 1984 to March, 2004 were traced and identified as relevant cases for this study. RESULTS: Allograft survival rate at 1, 3, 5, 10 years for poor HLA matched group and HLA haploidentical group were 100%, 98.6%, 95.4%, 72.5% and 100%, 100%, 96.1%, 86.2% (p=not significant) respectively. Acute rejection developed in 25.8% of poor HLA matched group versus 18.9% of HLA haploidentical group (p=not significant). The most common causes of graft failure in both groups were chronic rejection. CONCLUSIONS: It should be actively encouraged to consider renal transplantation in a poor HLA matched group as the results of this study support that the clinical outcomes of renal transplantation in a poor HLA matched group are equivalent to those of HLA haploidentical group.