J Korean Soc Transplant.  2015 Sep;29(3):160-165. 10.4285/jkstn.2015.29.3.160.

Treatment of Renal Transplant Recipients with Concurrent Acute Cellular Rejection and Transplant Renal Artery Stenosis

• Kim HY
• Yun JH
• Kim DH
• Lee JH
• Oh JS
• Kim SM
• Sin YH
• Kim JK
• Kim YJ

• KMID: 2202588
• DOI: http://doi.org/10.4285/jkstn.2015.29.3.160

Abstract

Transplant renal artery stenosis (TRAS) is a common surgical complication after kidney transplantation (KTP) and is the cause of allograft dysfunction. TRAS is a potentially curable cause of refractory hypertension and allograft dysfunction which accounts for approximately 1% to 5% of cases of post-transplant hypertension. Acute cellular rejection (ACR) is also common after KTP, which is the main cause of allograft dysfunction. Although the incidence of ACR has declined with the advent of new immunosuppressive drugs, it is still around 15% worldwide. Although each disease is frequently seen individually, seeing both together is rare. A 42-year-old man with end stage renal disease underwent KTP, and the donor was his younger brother. Four months after KTP, his serum creatinine was increased to 2.1 mg/dL, and renal biopsy showed interstitial lymphocytic infiltration and tubulitis. With the diagnosis of acute T-cell mediated rejection, steroid pulsing therapy was started, but it was resisted. Therefore thymoglobulin 60 mg (1 mg/kg/day) was administered for 6 days, but serum creatinine was 1.8 mg/dL. Abdomen magnetic resonance angiography showed TRAS, stenosis at the anastomosis site and lobar artery in the lower pole. Percutaneous transluminal angiography was performed successfully. After balloon angioplasty, the stenotic lesion showed a normal size and blood flow. The patient's renal function returned to normal levels and he is currently being followed up for 9 months.

Keyword

Transplant renal artery stenosis; Acute cellular rejection; Kidney transplantation

MeSH Terms

Abdomen
Adult
Allografts
Angiography
Angioplasty, Balloon
Arteries
Biopsy
Constriction, Pathologic
Creatinine
Diagnosis
Humans
Hypertension
Incidence
Kidney Failure, Chronic
Kidney Transplantation
Magnetic Resonance Angiography
Renal Artery Obstruction*
Renal Artery*
Siblings
T-Lymphocytes
Tissue Donors
Transplantation*
Creatinine

Figure

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  Fig. 1. Allograft biopsy shows diffuse infiltration of lymphocytes along the interstitium and tubulitis (arrows) (PAS, ×400).

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  Fig. 2. Magnetic resonance angiography (MRA) of the right grafted kidney, MRA showed focal stenosis at anastomotic site of transplanted renal A. and another focal stenosis at proximal inferior segmental A.

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  Fig. 3. (A) Renal angiogram showed end-to-side anastomosis state between the renal artery and the iliac artery of graft kidney. Severe stenosis showed at anastomosis site (black arrow) and lobar artery in lower pole (white arrow). (B) Post-renal angiogram from the same patient after angioplasty. Stenosis is completely improved.

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  Fig. 4. Clinical course. Abbreviations: ACR, acute cellular rejection; MR, magnetic resonance; TRAS, transplant renal artery stenosis.

Reference

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