A case of acute rejection with adenovirus infection after ABO‐incompatible kidney transplantation

• Published in: Clinical transplantation 2009-08, Vol.23 (s20), p.27-30
• Main Authors: Komiya, Toshiyuki, Goto, Norihiko, Takeda, Asami, Horike, Keiji, Onoda, Hiroshi, Sakai, Kaoru, Kitamura, Ken, Yamamoto, Keiko, Oikawa, Tadashi, Nagasaka, Takaharu, Hiramitsu, Takahisa, Simabukuro, Syuichi, Suzuki, Keisuke, Sato, Tetsuhiko, Yoshihiko, Watarai, Uchida, Kazuharu, Morozumi, Kunio
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System - immunology; Acute Disease; acute rejection; Adenovirus; Adenovirus Infections, Human - complications; Adenovirus Infections, Human - diagnosis; Adenovirus Infections, Human - virology; Adenoviruses, Human - immunology; Antibodies, Viral - analysis; Biological and medical sciences; Biopsy; Blood Group Incompatibility - immunology; Diagnosis, Differential; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - blood; Graft Rejection - diagnosis; Graft Rejection - etiology; Humans; Infectious diseases; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Medical sciences; Middle Aged; rivabirin; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Viral diseases
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2009.01005.x

:  We report clinical and histopathologic findings of a case of acute rejection with adenovirus infection after kidney transplantation. A 63‐yr‐old woman with end‐stage renal disease caused by lupus nephritis received an ABO‐incompatible living kidney transplantation from her husband. On the 7th post‐operative day (POD), she had fever, hematuria, and bladder irritation. Although she was treated with an antibiotic, the symptoms were not improved. We diagnosed adenovirus infection as positive with the urine shell vial method and blood PCR analysis. Cyclophosphamide was interrupted and immunoglobulin therapy was performed. However, urine output decreased and serum creatinine levels increased. An episode biopsy was performed on POD 20. We diagnosed acute antibody‐mediated rejection. She was treated with plasma exchange for acute rejection and antiviral drug (rivabirin) for active adenovirus infection. However, the renal graft dysfunction was deemed irreversible and the renal graft was removed on POD 34. The graftectomy specimen showed acute rejection and acute tubular necrosis with adenovirus infection.