Her anti-HLA (PRA) antibody profile was negative by Luminescence, and post transplant PRA became positive for class I, negative for class II, and revealed the following specificity: Class I positive, B7 = 4500MFI, with donor specific antibodies. Immunologically, pre-transplant T-cell cross match by complement dependent Cytotoxic (CDC) was negative, flow cytometric crossmatching (FXM) was negative, and HLA studies showed favorable mismatch 0,1,1 for A, B, DR. 2. Case reportĪ 42 year old woman, known case of end stage kidney disease, due to chronic hypertensive nephropathy, and chronic anemia, received a living-related kidney transplant from her 21 year old son. 3,6–9 We report the clinical presentation of severely ruptured renal allograft secondary to antibody-mediated rejection, and discuss the surgical and medical management, as well as the follow up and clinical outcome. Usually, nephrectomy is a necessary treatment measure, but conservative surgical intervention has also been successfully attempted to preserve the renal allograft. 3–5 Recognition and prompt management of allograft rupture is important due to its likely devastating clinical course and outcome. 1,2 Current immunosuppressive medication regimens contribute to a decreased incidence of allograft rupture. The majority of graft ruptures are immunologically-mediated and caused by acute rejection. It typically occurs in the first few weeks after transplantation, and it is associated with graft tenderness, hematoma and/or hypotension. Renal allograft rupture (RAR) is rare yet recognized potential complication of renal transplantation. Keywords: Allograft rupture, Renal allograft rupture, Antibody-mediated rejection, Graft, Transplant complications 1. Introduction With modern immunosuppression therapy and proven surgical procedures, the efficacy of salvaged renal grafts and graft survival rates may improve substantially.
#SINGLE COLLECTION ET KING RAR RAR#
Observations arising from this case are: (1) RAR caused by rejection is still encountered in clinical practice despite effective immunosuppressive management (2) the severity of the histopathological features of rejection does not necessarily correlate with the extent of graft rupture and (3) salvaging the graft should be attempted whenever possible as current immunosuppression and advances in surgical techniques may have an impact on long-term graft function and survival, differing from those previously published. The graft was surgically salvaged with excellent clinical and biochemical improvement. Histologically the graft demonstrated mild acute kidney injury and linear deposition of C4d along the cortical peritubular capillaries morphological features for violent humoral or cellular rejection were not identified. Surgical exploration showed 12 cm laceration along the convex border of the graft.
PRESENTATION OF CASEĪ 45-year-old, living-related, female, kidney allograft recipient experienced RAR on the fourth day post transplantation.
Debate on the management of RAR has focused on graft nephrectomy versus salvaging in cases where: the allograft rupture site is surgically manageable the bleeding can be controlled and/or leaving the renal allograft in situ does not compromise patient survival. Spontaneous renal allograft rupture (RAR) is a serious and potentially life-threatening complication of kidney transplantation. Keep Tryin’ LISMO! au LISTEN MOBILE SERVICE TVCM タイアップソングġ0.
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