The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Delayed Recovery from Antibody-Mediated Rejection

신 이식 후 항체 매개성 거부반응 환자에서 지연성 회복을 보인 치료 1예

  • Cho, Hyung Jin (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Eun Hye (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yang, Young Joo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Ji Won (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ji, Won Jun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Young Kwon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Su-Kil (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 조형진 (울산대학교 의과대학 서울아산병원 내과) ;
  • 신은혜 (울산대학교 의과대학 서울아산병원 내과) ;
  • 양영주 (울산대학교 의과대학 서울아산병원 내과) ;
  • 정지원 (울산대학교 의과대학 서울아산병원 내과) ;
  • 지원준 (울산대학교 의과대학 서울아산병원 내과) ;
  • 최영권 (울산대학교 의과대학 서울아산병원 내과) ;
  • 박수길 (울산대학교 의과대학 서울아산병원 내과)
  • Received : 2013.04.16
  • Accepted : 2013.08.12
  • Published : 2014.02.01
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Abstract

Antibody-mediated rejection (ABMR) in kidney transplant recipients is mediated by donor-specific antibodies. It is the major cause of graft failure in noncompliant patients and is associated with reduced long-term graft survival. We present a case of delayed recovery of renal function despite aggressive therapy after acute ABMR. A 49-year-old male on triple-drug maintenance immunosuppression (prednisolone, cyclosporine, and azathioprine), who underwent cadaveric donor renal transplantation 14 years earlier, visited our clinic with a serum creatinine level (SCr) of 1.9 mg/dL. The kidney biopsy revealed acute ABMR with diffuse C4d immunopositivity. We started steroid pulse therapy and bortezomib with plasmapheresis. Nevertheless, the SCr increased. Consequently, antithymocyte globulin (ATG) and intravenous immunoglobulin were administered. The SCr increased further to 4.1 mg/dL. Therefore, we performed a second kidney biopsy, which showed no change. Finally, we used rituximab. Fortunately, the SCr decreased gradually and returned to baseline.

항체 매개성 거부반응은 이식 신 기능상실에 중요한 원인으로 현재까지 확립된 치료방법이 없는 상태이다. 항체 매개성 거부반응의 원인으로 생각되는 제공자 특이 항체의 경우 면역억제제를 잘 복용하지 않아서 지연성으로 발생하는 경우가 있어, 지속적인 면역억제제 복용의 교육이 필요하다. 항체 매개성 거부반응에 있어 최근 치료로 도입된 bortezomib 단독치료로서 회복을 보이지 않았던 증례에서 rituximab을 추가로 치료하여 지연성 회복을 보인 증례를 보고하며 일반적인 치료법으로도 회복되지 않는 항체 매개성 거부반응에서 rituximab과 bortezomib의 병합치료를 고려해 볼 수 있겠고 추가적인 연구가 필요할 것으로 생각된다.

Keywords

References

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