Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literatures
Acute allograft dysfunction is rarely observed in kidney transplantation (KT). We report an unusual case of acute allograft dysfunction mimicking thrombotic microangiopathy (TMA) in recipient with renal infarction. A 65-year-old man underwent KT from his 39-year-old son. Pre-transplant donor evaluat...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Transplantation
2020-12-01
|
| Series: | Korean Journal of Transplantation |
| Subjects: | |
| Online Access: | http://journaleditor.inforang.com/journal/view.html?doi=10.4285/kjt.20.0034 |
| _version_ | 1827393831140589568 |
|---|---|
| author | Sua Lee Lo-Yi Ho Byung Ha Chung Sun Cheol Park Chul Woo Yang |
| author_facet | Sua Lee Lo-Yi Ho Byung Ha Chung Sun Cheol Park Chul Woo Yang |
| author_sort | Sua Lee |
| collection | DOAJ |
| description | Acute allograft dysfunction is rarely observed in kidney transplantation (KT). We report an unusual case of acute allograft dysfunction mimicking thrombotic microangiopathy (TMA) in recipient with renal infarction. A 65-year-old man underwent KT from his 39-year-old son. Pre-transplant donor evaluation was normal except for the branches of the upper and lower pole renal arteries originating from the aorta in renal computed topographic angiography, respectively. The immediate post-transplant clinical course was uneventful, but serum creatinine (SCr) increased from 2.2 to 4.5 mg/dL, anemia and thrombocytopenia were shown, and serum lactate dehydrogenase increased to 919 U/L on the third day after transplantation. We suspected TMA, because of no evidence of acute bleeding. The laboratory parameters associated with TMA were within normal ranges. Renal magnetic resonance angiography revealed a focal wedge-shaped perfusion defect in the upper pole of the graft and renal Doppler ultrasonography showed decreased perfusion of the lower pole of the graft. Graft function improved with conservative therapy. The patient was discharged with SCr of 1.21 mg/dL. Graft function has been stable after discharge. Acute allograft infarction should be considered in the differential diagnosis of acute allograft dysfunction mimicking TMA in recipients with grafts supplied by multiple renal arteries. |
| first_indexed | 2024-03-08T17:56:04Z |
| format | Article |
| id | doaj.art-4982e7f09b0b4c7e96a2efb758446ea1 |
| institution | Directory Open Access Journal |
| issn | 2671-8790 |
| language | English |
| last_indexed | 2024-03-08T17:56:04Z |
| publishDate | 2020-12-01 |
| publisher | Korean Society for Transplantation |
| record_format | Article |
| series | Korean Journal of Transplantation |
| spelling | doaj.art-4982e7f09b0b4c7e96a2efb758446ea12024-01-02T04:34:13ZengKorean Society for TransplantationKorean Journal of Transplantation2671-87902020-12-0134427227810.4285/kjt.20.0034kjt.20.0034Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literaturesSua Lee0Lo-Yi Ho1Byung Ha Chung2Sun Cheol Park3Chul Woo Yang4Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, KoreaDepartment of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, ChinaTransplant Research Center, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaDivision of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, KoreaTransplant Research Center, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaAcute allograft dysfunction is rarely observed in kidney transplantation (KT). We report an unusual case of acute allograft dysfunction mimicking thrombotic microangiopathy (TMA) in recipient with renal infarction. A 65-year-old man underwent KT from his 39-year-old son. Pre-transplant donor evaluation was normal except for the branches of the upper and lower pole renal arteries originating from the aorta in renal computed topographic angiography, respectively. The immediate post-transplant clinical course was uneventful, but serum creatinine (SCr) increased from 2.2 to 4.5 mg/dL, anemia and thrombocytopenia were shown, and serum lactate dehydrogenase increased to 919 U/L on the third day after transplantation. We suspected TMA, because of no evidence of acute bleeding. The laboratory parameters associated with TMA were within normal ranges. Renal magnetic resonance angiography revealed a focal wedge-shaped perfusion defect in the upper pole of the graft and renal Doppler ultrasonography showed decreased perfusion of the lower pole of the graft. Graft function improved with conservative therapy. The patient was discharged with SCr of 1.21 mg/dL. Graft function has been stable after discharge. Acute allograft infarction should be considered in the differential diagnosis of acute allograft dysfunction mimicking TMA in recipients with grafts supplied by multiple renal arteries.http://journaleditor.inforang.com/journal/view.html?doi=10.4285/kjt.20.0034kidney transplantation; primary graft dysfunction; thrombotic microangiopathy |
| spellingShingle | Sua Lee Lo-Yi Ho Byung Ha Chung Sun Cheol Park Chul Woo Yang Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literatures Korean Journal of Transplantation kidney transplantation; primary graft dysfunction; thrombotic microangiopathy |
| title | Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literatures |
| title_full | Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literatures |
| title_fullStr | Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literatures |
| title_full_unstemmed | Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literatures |
| title_short | Acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction: case report and review of literatures |
| title_sort | acute allograft dysfunction mimicking thrombotic microangiopathy in kidney transplant recipient with renal infarction case report and review of literatures |
| topic | kidney transplantation; primary graft dysfunction; thrombotic microangiopathy |
| url | http://journaleditor.inforang.com/journal/view.html?doi=10.4285/kjt.20.0034 |
| work_keys_str_mv | AT sualee acuteallograftdysfunctionmimickingthromboticmicroangiopathyinkidneytransplantrecipientwithrenalinfarctioncasereportandreviewofliteratures AT loyiho acuteallograftdysfunctionmimickingthromboticmicroangiopathyinkidneytransplantrecipientwithrenalinfarctioncasereportandreviewofliteratures AT byunghachung acuteallograftdysfunctionmimickingthromboticmicroangiopathyinkidneytransplantrecipientwithrenalinfarctioncasereportandreviewofliteratures AT suncheolpark acuteallograftdysfunctionmimickingthromboticmicroangiopathyinkidneytransplantrecipientwithrenalinfarctioncasereportandreviewofliteratures AT chulwooyang acuteallograftdysfunctionmimickingthromboticmicroangiopathyinkidneytransplantrecipientwithrenalinfarctioncasereportandreviewofliteratures |