血漿交換が奏効した生体腎移植術後促進型急性拒絶反応の1例

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30歳女,患者は生体腎移植術を希望し,実母をドナーとして生体腎移植が施行された.だが,術後24時間以降において促進型急性拒絶反応と診断し,ステロイドパルス療法が施行された.更に新鮮凍結血漿60単位を置換液として血漿交換(PE)を行ない,術後8,9日目にDFPP(double filtered plasmapheresis)が施行された.その結果,術後6日目より尿量の増加を認め,術後12日目には腎機能が改善し安定した.術後51日目にサイトメガロウイルス(CMV)抗体価が陽性となったが,これはガンシクロビルより陰性化した.以後,18ヵ月経過した現在,良好な腎機能を保っているA 30-year-old female received living donor kidney transplantation from her mother. The surgical procedure was uneventfully performed and urine output was observed a few minutes after reperfusion. However, 24 hours after the surgery, the urine volume rapidly decreased with worsened renal blood flow as determined by Doppler ultrasonography, diagnosed as accelerated acute rejection (AAR). Plasma exchange (PE) combined with therapies including administration of steroids and OKT3 dramatically improved the renal status, resulting in maintenance of good renal function (serum Cr; 1.5 mg/dl) even after 18 months PE was considered as a powerful tool for AAR, and the literature was reviewed.