scholarly journals Late Renal Allograft Rupture Associated with Cessation of Immunosuppression following Graft Failure

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sumayah Askandarani ◽  
Noura Aloudah ◽  
Hanan Al Enazi ◽  
Khaled O. Alsaad ◽  
Abdulrahman Altamimi
Keyword(s):  
Graft Failure ◽  
Unusual Case ◽  
Renal Allograft ◽  
Time Interval ◽  
Antibody Mediated Rejection ◽  
Immunosuppressive Medications ◽  
Peritubular Capillaries ◽  
Long Time ◽  
Cellular Rejection ◽  
Marked Drop

A 29-year-old man developed chronic allograft nephropathy 63 months after renal transplantation. He became symptomatic with advanced chronic graft failure; his immunosuppressive medications were reduced and he was commenced on haemodialysis. Two months following the withdrawal of immunosuppression, he presented with abdominal pain, haematuria, and a marked drop in haemoglobin. The patient was taken to the operating room, where the renal allograft was found to be ruptured, and graft nephrectomy was subsequently performed. Histological examination of the graft specimen showed severe haemorrhagic acute vascular cellular rejection in a background of marked chronic allograft vasculopathy. Immunostaining for C4d showed diffuse, strong, linear circumferential staining of the peritubular capillaries, indicating a concurrent antibody-mediated rejection. We report herein an unusual case of spontaneous renal allograft rupture that occurred long time after transplantation due to severe acute rejection following cessation of immunosuppressive medications for advanced chronic allograft failure. To the best of our knowledge, the time interval between transplantation and the rupture of this allograft is the longest of those reported in the literature.

scholarly journals Pure T-cell mediated rejection following kidney transplant according to response to treatment

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256898
Author(s):  
Hyunwook Kwon ◽  
Young Hoon Kim ◽  
Youngmin Ko ◽  
Seong Jun Lim ◽  
Joo Hee Jung ◽  
...  
Keyword(s):  
T Cell ◽  
Graft Failure ◽  
Significant Risk ◽  
Diagnostic System ◽  
Significant Risk Factor ◽  
Response To Treatment ◽  
Histologic Diagnosis ◽  
Antibody Mediated Rejection ◽  
Long Time ◽  
The Impact

The focus of studies on kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on graft survival (GS) according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system on a separate group of 23 patients. A total of 63 patients were divided into non-responders (N = 22) and responders (N = 44). Non-response to rejection treatment was significantly associated with the following factors: glomerular filtration rate (GFR) at biopsy, ΔGFR, TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (OR = 3.31; P = 0.036) and lower GFR at biopsy (OR = 0.56; P = 0.026) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P = 0.004). Molecular assessment showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment.

scholarly journals C4d-Positive Acute Humoral Renal Allograft Rejection: Effective Treatment by Immunoadsorption

2001 ◽  
Vol 12 (11) ◽  
pp. 2482-2489 ◽  
Author(s):  
GEORG A. BÖHMIG ◽  
HEINZ REGELE ◽  
MARKUS EXNER ◽  
VICTOR DERHARTUNIAN ◽  
JOSEF KLETZMAYR ◽  
...  
Keyword(s):  
Allograft Rejection ◽  
Renal Allograft ◽  
Graft Function ◽  
Treatment Modalities ◽  
Graft Dysfunction ◽  
Pathogenetic Role ◽  
Renal Allograft Rejection ◽  
Peritubular Capillaries ◽  
Cellular Rejection

Abstract. There is increasing evidence for an important pathogenetic role of alloantibodies in acute renal allograft rejection. Acute humoral rejection (AHR) has been reported to be associated with a poor transplant survival. Although treatment modalities for cellular rejection are fairly well established, the optimal treatment for AHR remains undefined. Ten of 352 kidney allograft recipients transplanted at the authors' institution between November 1998 and September 2000 were diagnosed as having AHR, supported by severe graft dysfunction, C4d deposits in peritubular capillaries (PTC), and accumulation of granulocytes in PTC. AHR was diagnosed 18.9 ± 17.5 d posttransplantation. All patients were subjected to immunoadsorption (IA) with protein A (median number of treatment sessions, 9; range, 3 to 17). Seven recipients with additional signs of cellular rejection (according to the Banff classification) received also antithymocyte globulin. In nine of ten patients, AHR was associated with an increase in panel reactive antibody reactivity. A pathogenetic role of alloantibodies was further supported by a positive posttransplant cytotoxic crossmatch in all tested recipients (n= 4). In nine of ten recipients, renal function recovered after initiation of anti-humoral therapy. One patient lost his graft shortly after initiation of specific therapy. Another recipient with partial reversal of AHR returned to dialysis 8 mo after transplantation. Mean serum creatinine in functioning grafts was 2.2 ± 1.2 mg/dl after the last IA session (n= 9) and 1.5 ± 0.5 mg/dl after a follow-up of 14.2 ± 7.1 mo (n= 8). In conclusion, this study suggests that AHR, characterized by severe graft dysfunction, C4d staining, and peritubular granulocytes, can be effectively treated by timely IA. In the majority of patients, IA treatment can restore excellent graft function over a prolonged time period.

scholarly journals Acute Humoral Rejection in Kidney Transplantation: II. Morphology, Immunopathology, and Pathologic Classification

2002 ◽  
Vol 13 (3) ◽  
pp. 779-787 ◽  
Author(s):  
Shamila Mauiyyedi ◽  
Marta Crespo ◽  
A. Bernard Collins ◽  
Eveline E. Schneeberger ◽  
Manuel A. Pascual ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Graft Failure ◽  
Renal Allograft ◽  
Periodic Acid ◽  
Fibrinoid Necrosis ◽  
Humoral Rejection ◽  
Peritubular Capillaries ◽  
Significant Difference ◽  
Pathologic Classification ◽  
C4d Staining

ABSTRACT. The incidence of acute humoral rejection (AHR) in renal allograft biopsies has been difficult to determine because widely accepted diagnostic criteria have not been established. C4d deposition in peritubular capillaries (PTC) of renal allografts has been proposed as a useful marker for AHR. This study was designed to test the relative value of C4d staining, histology, and serology in the diagnosis of AHR. Of 232 consecutive kidney transplants performed at a single institution from July 1995 to July 1999, all patients (n = 67) who developed acute rejection within the first 3 mo and had a renal biopsy with available frozen tissue at acute rejection onset, as well as posttransplant sera within 30 d of the biopsy, were included in this study. Hematoxylin and eosin and periodic acid-Schiff stained sections were scored for glomerular, vascular, and tubulointerstitial pathology. C4d staining of cryostat sections was done by a sensitive three-layer immunofluorescence method. Donor-specific antibodies (DSA) were detected in posttransplant recipient sera using antihuman-globulin–enhanced T cell and B cell cytotoxicity assays and/or flow cytometry. Widespread C4d staining in PTC was present in 30% (20 of 67) of all acute rejection biopsies. The initial histologic diagnoses of the C4d+ acute rejection cases were as follows: AHR only, 30%; acute cellular rejection (ACR) and AHR, 45%; ACR (CCTT types 1 or 2) alone, 15%; and acute tubular injury (ATI), 10%. The distinguishing morphologic features in C4d+versus C4d− acute rejection cases included the following: neutrophils in PTC, 65% versus 9%; neutrophilic glomerulitis, 55% versus 4%; neutrophilic tubulitis, 55% versus 9%; severe ATI, 75% versus 9%; and fibrinoid necrosis in glomeruli, 20% versus 0%, or arteries, 25% versus 0%; all P < 0.01. Mononuclear cell tubulitis was more common in the C4d− group (70% versus 100%; P < 0.01). No significant difference between C4d+ and C4d− acute rejection was noted for endarteritis, 25% versus 32%; interstitial inflammation (mean % cortex), 27.2 ± 27% versus 38 ± 21%; interstitial hemorrhage, 25% versus 15%; or infarcts, 5% versus 2%. DSA were present in 90% (18 of 20) of the C4d+ cases compared with 2% (1 of 47) in the C4d− acute rejection cases (P < 0.001). The pathology of the C4d+ but DSA− cases was not distinguishable from the C4d+, DSA+ cases. The C4d+ DSA− cases may be due to non-HLA antibodies or subthreshold levels of DSA. The sensitivity of C4d staining is 95% in the diagnosis of AHR compared with the donor-specific antibody test (90%). Overall, eight grafts were lost to acute rejection in the first year, of which 75% (6 of 8) had AHR. The 1-yr graft failure rate was 27% (4 of 15) for those AHR cases with only capillary neutrophils versus 40% (2 of 5) for those who also had fibrinoid necrosis of arteries. In comparison, the 1-yr graft failure rates were 3% and 7%, respectively, in ACR 1 (Banff/CCTT type 1) and ACR 2 (Banff/CCTT type 2) C4d− groups. A substantial fraction (30%) of biopsy-confirmed acute rejection episodes have a component of AHR as judged by C4d staining; most (90%), but not all, have detectable DSA. AHR may be overlooked in the presence of ACR or ATI by histology or negative serology, arguing for routine C4d staining of renal allograft biopsies. Because AHR has a distinct therapy and prognosis, we propose that it should be classified separately from ACR, with further sub-classification into AHR 1 (neutrophilic capillary involvement) and AHR 2 (arterial fibrinoid necrosis).

An Adaptive and Learning System for Feedback-Controlled Evoked Response Studies

1981 ◽  
Vol 20 (03) ◽  
pp. 169-173
Author(s):  
J. Wagner ◽  
G. Pfurtscheixer
Keyword(s):  
Brain Activity ◽  
Evoked Response ◽  
Learning System ◽  
Time Interval ◽  
Electrical Brain Activity ◽  
Long Time ◽  
The Subject ◽  
Eeg Power ◽  
Stimulation System ◽  
Background Eeg

The shape, latency and amplitude of changes in electrical brain activity related to a stimulus (Evoked Potential) depend both on the stimulus parameters and on the background EEG at the time of stimulation. An adaptive, learnable stimulation system is introduced, whereby the subject is stimulated (e.g. with light), whenever the EEG power is subthreshold and minimal. Additionally, the system is conceived in such a way that a certain number of stimuli could be given within a particular time interval. Related to this time criterion, the threshold specific for each subject is calculated at the beginning of the experiment (preprocessing) and adapted to the EEG power during the processing mode because of long-time fluctuations and trends in the EEG. The process of adaptation is directed by a table which contains the necessary correction numbers for the threshold. Experiences of the stimulation system are reflected in an automatic correction of this table. Because the corrected and improved table is stored after each experiment and is used as the starting table for the next experiment, the system >learns<. The system introduced here can be used both for evoked response studies and for alpha-feedback experiments.

Unusual Case of AneuRx Stent-Graft Failure Two Years After AAA Exclusion

2001 ◽  
Vol 8 (5) ◽  
pp. 465-471 ◽  
Author(s):  
Zvonimir Krajcer ◽  
Marcus Howell ◽  
Kathy Dougherty
Keyword(s):  
Stent Graft ◽  
Graft Failure ◽  
Unusual Case

Acute Rejection Following Kidney Transplantation: State-of-the-Art and Future Perspectives

2020 ◽  
Vol 26 (28) ◽  
pp. 3468-3496
Author(s):  
Emilio Rodrigo ◽  
Marcio F. Chedid ◽  
David San Segundo ◽  
Juan C.R. San Millán ◽  
Marcos López-Hoyos
Keyword(s):  
Kidney Transplantation ◽  
Acute Rejection ◽  
Rescue Therapy ◽  
Standard Of Care ◽  
Rejection Rate ◽  
New Drugs ◽  
High Dose ◽  
Current Standard ◽  
Antibody Mediated Rejection ◽  
Cellular Rejection

: Although acute renal graft rejection rate has declined in the last years, and because an adequate therapy can improve graft outcome, its therapy remains as one of the most significant challenges for pharmacists and physicians taking care of transplant patients. Due to the lack of evidence highlighted by the available metaanalyses, we performed a narrative review focused on the basic mechanisms and current and future therapies of acute rejection in kidney transplantation. : According to Kidney Disease/Improving Global Outcomes (KDIGO) guidelines, both clinical and subclinical acute rejection episodes should be treated. Usually, high dose steroids and basal immunosuppression optimization are the first line of therapy in treating acute cellular rejection. Rabbit antithymocytic polyclonal globulins are used as rescue therapy for recurrent or steroid-resistant cellular rejection episodes. Current standard-of-care (SOC) therapy for acute antibody-mediated rejection (AbMR) is the combination of plasma exchange with intravenous immunoglobulin (IVIG). Since a significant rate of AbMR does not respond to SOC, different studies have analyzed the role of new drugs such as Rituximab, Bortezomib, Eculizumab and C1 inhibitors. Lack of randomized controlled trials and heterogenicity among performed studies limit obtaining definite conclusions. Data about new direct and indirect B cell and plasma cell depleting agents, proximal and terminal complement blockers, IL-6/IL-6R pathway inhibitors and antibody removal agents, among other promising drugs, are reviewed.

scholarly journals Optimal Perturbations of an Oceanic Vortex Lens

Fluids ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 63 ◽  
Author(s):  
Thomas Meunier ◽  
Claire Ménesguen ◽  
Xavier Carton ◽  
Sylvie Le Gentil ◽  
Richard Schopp
Keyword(s):  
Normal Mode ◽  
Growth Rates ◽  
Time Interval ◽  
Time Intervals ◽  
Horizontal Structure ◽  
Azimuthal Wave ◽  
Wave Numbers ◽  
Non Linear ◽  
Long Time ◽  
Short Time

The stability properties of a vortex lens are studied in the quasi geostrophic (QG) framework using the generalized stability theory. Optimal perturbations are obtained using a tangent linear QG model and its adjoint. Their fine-scale spatial structures are studied in details. Growth rates of optimal perturbations are shown to be extremely sensitive to the time interval of optimization: The most unstable perturbations are found for time intervals of about 3 days, while the growth rates continuously decrease towards the most unstable normal mode, which is reached after about 170 days. The horizontal structure of the optimal perturbations consists of an intense counter-shear spiralling. It is also extremely sensitive to time interval: for short time intervals, the optimal perturbations are made of a broad spectrum of high azimuthal wave numbers. As the time interval increases, only low azimuthal wave numbers are found. The vertical structures of optimal perturbations exhibit strong layering associated with high vertical wave numbers whatever the time interval. However, the latter parameter plays an important role in the width of the vertical spectrum of the perturbation: short time interval perturbations have a narrow vertical spectrum while long time interval perturbations show a broad range of vertical scales. Optimal perturbations were set as initial perturbations of the vortex lens in a fully non linear QG model. It appears that for short time intervals, the perturbations decay after an initial transient growth, while for longer time intervals, the optimal perturbation keeps on growing, quickly leading to a non-linear regime or exciting lower azimuthal modes, consistent with normal mode instability. Very long time intervals simply behave like the most unstable normal mode. The possible impact of optimal perturbations on layering is also discussed.

scholarly journals Preceding T-Cell-Mediated Rejection Is Associated with the Development of Chronic Active Antibody-Mediated Rejection by de Novo Donor-Specific Antibody

Nephron ◽  
2020 ◽  
pp. 1-5
Author(s):  
Takahiro Tsuji ◽  
Sari Iwasaki ◽  
Keishi Makita ◽  
Teppei Imamoto ◽  
Naomichi Ishidate ◽  
...  
Keyword(s):  
T Cell ◽  
Specific Antibody ◽  
De Novo ◽  
Control Group ◽  
Antibody Mediated Rejection ◽  
Peritubular Capillaries ◽  
The Mean ◽  
Microvascular Inflammation ◽  
Renal Allograft Loss ◽  
Allograft Loss

<b><i>Aim:</i></b> Chronic active antibody-mediated rejection (CAABMR) is an important cause of late-stage renal allograft loss. Early inflammatory events such as acute rejection and infection after transplantation are considered to be the risk factors of de novo donor-specific antibody (dnDSA) production. In this study, we investigated the relationship between pre­disposing T-cell-mediated rejection and dnDSA-positive CAABMR. <b><i>Methods:</i></b> We recruited 365 patients who underwent ABO-compatible renal transplantation at our hospital. Among them, 16 patients diagnosed as having dnDSA-positive CAABMR were designated as a CAABMR group, and 38 randomly selected patients were designated as a control group. All biopsies from 1 month after transplantation were included in the study. The presence or absence of borderline changes (BLCs), acute T-cell-mediated rejection (ATMR), microvascular inflammation (MVI), and C4d positive on peritubular capillaries (C4d-P) was examined. <b><i>Results:</i></b> In the CAABMR group, BLC/ATMR was found in 12 cases (75%), and the mean duration until appearance of BLC/ATMR was 282.7 ± 328.7 days. C4d-P was found in 11 cases (68.8%), and the mean duration until its appearance was 1,432 ± 1,307 days. MVI was found in all cases, and the mean duration until its appearance was 1,333 ± 1,126 days. The mean duration until diagnosis of CAABMR was 2,268 ± 1,191 days. In the control group, BLC/ATMR was found in 13 cases (34.2%), and the mean duration until the appearance of BLC/ATMR was 173.1 ± 170.4 days. C4d-P was found in 2 cases (5.3%), and the durations until its appearance were 748 and 1,881 days. No cases of MVI were found in the control group. The frequency of BLC/ATMR was significantly higher in the CAABMR group (<i>p</i> &#x3c; 0.01). <b><i>Conclusion:</i></b> Preceding BLC/ATMR is associated with the development of CAABMR with dnDSA.

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