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Title: | Recurrence of anti-neutrophil cytoplasmic antibody vasculitis in the kidney allograft. | Authors: | Lau D.;Mulley W. ;Simpson I.;Amos L.;Summers S. | Institution: | (Lau, Summers, Amos, Mulley) Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia (Simpson) Department of Pathology, Monash Medical Centre, Clayton, VIC, Australia (Summers, Mulley) Department of Medicine, Monash University, Clayton, VIC, Australia | Issue Date: | 26-Apr-2012 | Copyright year: | 2012 | Publisher: | Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053, Australia) | Place of publication: | Australia | Publication information: | Nephrology. 17 (SUPPL. 1) (pp 16-19), 2012. Date of Publication: April 2012. | Abstract: | We report a case of recurrent anti-cytoplasmic neutrophil antibody (ANCA)- associated vasculitis post kidney transplantation. A 60-year-old woman underwent uncomplicated deceased-donor kidney transplantation for endstage renal disease (ESRD) secondary to myeloperoxidase-specific ANCAassociated vasculitis, after six years of haemodialysis, and clinical remission. Immunosuppression was with Tacrolimus/Mycophenolate and Prednisolone after Basiliximab induction therapy. Five weeks post-transplantation, an allograft biopsy, done for a rising creatinine and glomerular haematuria, revealed pauci-immune crescentic glomerulonephritis. This was treated with pulse Methylprednisolone, increase in maintenance Prednisolone, 7 sessions of plasma exchange, and replacement of Mycophenolate with Cyclophosphamide. Tacrolimus was continued throughout. After 3 months of therapy a repeat allograft biopsy showed quiescent vasculitis. The Cyclophosphamide was then ceased, and Mycophenolate reinstituted. The patient has maintained clinical and histological stability. Reported rates of ANCA-associated vasculitis recurrence post-kidney transplantation have varied but are low compared with other types of glomerulonephritis and seemed to have further declined in the era of modern immunosuppression. Given the low recurrence rate and excellent outcomes in suitable patients, kidney transplantation remains the optimal form of renal replacement therapy for ESRD due to ANCA-associated vasculitis. Whilst re-introduction of Cyclophosphamide has been the mainstay of therapy, additional reported successful therapeutic strategies have included pulse Methylprednisolone, Plasma Exchange and Rituximab. Further study on the most effective and safest treatment options would be of use given the current paucity of data in this area. © 2012 The Authors Nephrology © 2012 Asian Pacific Society of Nephrology. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/j.1440-1797.2012.01586.x | PubMed URL: | 22497649 [http://www.ncbi.nlm.nih.gov/pubmed/?term=22497649] | ISSN: | 1320-5358 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/28208 | Type: | Article | Subjects: | kidney biopsy kidney failure/su [Surgery] kidney failure/th [Therapy] adult *ANCA associated vasculitis/co [Complication] article case report drug efficacy drug safety drug withdrawal female glomerulonephritis/dt [Drug Therapy] glomerulonephritis/th [Therapy] glomerulus hematuria hemodialysis human immunosuppressive treatment *kidney allograft kidney transplantation plasmapheresis postoperative complication/co [Complication] priority journal recurrence risk remission renal replacement therapy treatment duration treatment outcome basiliximab/cb [Drug Combination] creatinine/ec [Endogenous Compound] cyclophosphamide/dt [Drug Therapy] cyclophosphamide/po [Oral Drug Administration] methylprednisolone/dt [Drug Therapy] mycophenolic acid/cb [Drug Combination] myeloperoxidase/ec [Endogenous Compound] prednisolone/cb [Drug Combination] prednisolone/dt [Drug Therapy] tacrolimus/cb [Drug Combination] glomerulus hematuria hemodialysis human immunosuppressive treatment *kidney allograft kidney biopsy kidney failure / surgery / therapy kidney transplantation plasmapheresis postoperative complication / complication article recurrence risk remission renal replacement therapy treatment duration treatment outcome priority journal adult *ANCA associated vasculitis / *complication case report drug efficacy drug safety drug withdrawal female glomerulonephritis / drug therapy / therapy |
Type of Clinical Study or Trial: | Case series or case report |
Appears in Collections: | Articles |
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