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2013 ; 29
(1-4
): 114-7
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Acute transplant glomerulopathy with monocyte rich infiltrate
#MMPMID24056179
Lenihan CR
; Tan JC
; Kambham N
Transpl Immunol
2013[Dec]; 29
(1-4
): 114-7
PMID24056179
show ga
Acute transplant glomerulopathy refers to alloimmune mediated endothelial injury
and glomerular inflammation that typically occurs early post-kidney
transplantation. We report a case of a 48-year old woman with end stage renal
disease from lupus nephritis who developed an unexplained rise in serum
creatinine 2 months after renal transplant. As immunosuppression, she received
alemtuzumab induction followed by a tacrolimus, mycophenolate mofetil and
prednisone maintenance regimen. Her biopsy revealed severe glomerular endothelial
injury associated with monocyte/macrophage-rich infiltrate in addition to mild
acute tubulointerstitial cellular rejection. We briefly discuss acute transplant
glomerulitis, its pathology and association with chronic/overt transplant
glomerulopathy, C4d negative antibody-mediated rejection and the significance of
monocytes in rejection. We also postulate that alemtuzumab induction may have
contributed to the unusual pattern of monocyte-rich transplant glomerulitis.