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논문분류	춘계학술대회 초록집
제목	A Case of desensitization, Transplantation, and early antibody mediated rejection in a negative flow cross-match and pretransplant donor-specific antibody
저자	*Yong hun SIN
출판정보	2017; 2017(1):
키워드	DSA, donor specific antibody; plasmapheresis
초록	Case Study : Pre-transplant (Tx) presence of donor specific HLA antibodies (DSAs) has been correlated with post-transplant rejection. But the clinical relevance of pre-Tx DSAs in flow crossmatch negative kidney transplant recipients remains unclear. Here we report the successful treatment of early acute antibody mediated rejection(AMR) that is occurred despite of preemptive desensitization in a negative flow cross-match and pre-Tx DSAs. A 34-yeatold female underwent kidney transplantation from her husband in February 2017. She was treated pre-operatively with rituximab (200mg/body) and three times of plasmapheresis because DSAs detected by Luminex Single Antigen Bead(SAB) assay in the absence of positive complement-dependent cytotoxicity(CDC) crossmatch and flow crossmach. She was treated with Tacrolimus and Mycophenolate mofetil and prednisolone and Simulect(an IL-2 blocking agent). After transplantation ,the renal allograft functioned immediately . On POD1, the serum creatinine was 0.9mg/dl and 1 hour protocol biopsy revealed non specific finding(fig 1). On POD6 her serum creatinine had increased from 0.9 to 1.5mg/dl and episode graft biopsy showed peritubular capilaritis( ptc 2) and C4d deposition in PTC(fig 2). In that time, rechecked result of T-cell flow cross match was changed to positive from negative and DSAs still showed positive result(fig 1). On POD12, The serum creatinine fell to 1.1mg/dl after 3 days of intravenous thymoglobulin and 4 times of plasmaphereis(fig 1). During last follow-up visit(POD 45) renal function had been maintained with a serum creatine level of 0.9mg/dl despite presence of DSA(fig 1).
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