Korean Journal of Nephrology 2009;28(4):375-380.
Intravenous Immunoglobulin Treatment in a Kidney Transplant Patient with Chronic Antibody-Mediated Rejection.
Seung Woon Byun, M.D.1, Youngsun Yeo, M.D.1, Jung Sik Park, M.D.1, Yong Mee Cho, M.D.2 and Su-Kil Park, M.D.1
Department of Internal Medicine1
and Pathology2
University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
증례 : 만성 항체 매개성 거부 반응에서 경정맥 면역 글로불린으로 치료한 1예
변승운1, 여영선1, 박정식1, 조영미2, 박수길1
울산대학교 의과대학 서울아산병원 신장내과1, 진단병리과2
Abstract
A 66-year-old male was admitted for increasing azotemia. He was diagnosed with chronic antibody- mediated rejection and had received a livingdonor renal transplant from his 32-year-old son prior to his admission. The peritubular capillaries of his kidney were diffusely positive on C4d immunostaining. It is known that there is an agreement between C4d staining and serological and histopathological data during rejection that is thought to have a humoral component. The role of alloantibodies in chronic renal allograft deterioration and the corresponding morphologic changes have been increasingly recognized during the recent years. However the treatment guidelines for chronic antibody-mediated rejection have not yet been established. Intravenous immunoglobulin (IVIG) has been shown to decrease the titers of anti-HLA antibodies in highly sensitized patients awaiting transplant. There are also numerous proposed mechanisms regarding how IVIG exerts its immunomodulatory action. As we have experienced chronic antibody-mediated rejection and how IVIG treatment improves renal function, we recognize that IVIG has the potential to be used for treating certain subgroups of chronic allograft nephropathy patients with positive C4d staining and anti-HLA antibodies.
Key Words: Complement component 4d, Rejection, Intravenous immunoglobulins, Human leukocyte antigens


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