J Korean Med Sci.  2012 Jul;27(7):814-817. 10.3346/jkms.2012.27.7.814.

Kidney Transplantation in a Patient with End Stage Renal Disease after Complete Remission of Acute Promyelocytic Leukemia

• Chun HJ
• Kim SJ
• Sun IO
• Chung BH
• Kim JI
• Moon IS
• Min WS
• Yang CW

• KMID: 2157930
• DOI: http://doi.org/10.3346/jkms.2012.27.7.814

Abstract

In general, a 2-yr disease-free duration is recommended before kidney transplantation (KT) in end-stage renal disease (ESRD) patients who also have acute leukemia. However, the optimal disease-free interval has not been specified for all subtypes of acute leukemia. Among these subtypes, acute promyelocytic leukemia (APL) shows a favorable prognosis and low relapse rate compared to other types of leukemia. We here report KT after complete remission (CR) of APL in an ESRD patient. Irreversible kidney injury developed in a 23-yr-old man with APL. First, we induced CR and subsequently performed KT 7 months after the achievement of CR. The patient's clinical course after KT was favorable, without allograft rejection or relapse of APL up to1 yr after KT. On the basis of our clinical experience, it is suggested that a long wait may not be necessary before KT in patients with ESRD and APL.

Keyword

Kidney Transplantation; Leukemia, Promyelocytic, Acute; End Stage Renal Disease

MeSH Terms

Adult
Antineoplastic Agents/therapeutic use
Arsenicals/therapeutic use
Bone Marrow Cells/pathology
Humans
Kidney Failure, Chronic/*therapy/ultrasonography
*Kidney Transplantation
Leukemia, Promyelocytic, Acute/*diagnosis/drug therapy
Male
Oxides/therapeutic use
Receptors, Retinoic Acid/genetics/metabolism
Remission Induction
Antineoplastic Agents
Arsenicals
Oxides
Receptors, Retinoic Acid

Figure

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  Fig. 1 Bone marrow aspiration finding (Wright's stain, × 1,000). Abnormal promyelocytes with prominent cytoplasmic granules were found. It is consistent with acute promyelocytic leukemia.

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  Fig. 2 Kidney ultrasonography finding. Before transplantation, ultrasonography showed decreased kidney size (right 8.4 × 4 × 3 cm, left 8.5 × 4 × 3 cm) and lobulated contour and increased parenchymal echogenicity (arrow). Above finding suggest the advanced chronic change of kidney.

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  Fig. 3 Protocol allograft biopsy finding (H&E stain, × 100). Protocol biopsy performed at 3 months after transplantation showed non-specific findings without tubulitis or interstitial infiltration.

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  Fig. 4 Clinical course of the patient. CR was achieved at 3 months after the initiation of treatment. Bone marrow biopsy was done total 6 times, four was done first every month after CR and the last biopsy was performed at 17 month after CR, there is no evidence of relapse. Until 9 months from the start of hemodialysis, renal function did not recover and KT was performed. After KT, renal function was normalized immediately, and patient's clinical course was stable until last follow up (2 yr). He is taking triple immune suppressant; tacrolimus, mycophenolic acid, prednisolone. CRRT, continuous renal replacement therapy; HD, hemodialysis; KT, kidney transplantation; CR, complete remission; RQ-PCR, Real-time quantitative polymerase chain reaction; BM biopsy, bone marrow biopsy; Tac, Tacrolimus; MMF, mycophenolic acid.

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