Exacerbation of intimal fibrosis and endarteritis in a kidney transplant recipient with chronic active antibody-mediated rejection and COVID-19 : a case report

Otsuka, Takuya; Tanabe, Tatsu; Hotta, Kiyohiko; Iwasaki, Sari; Tsuji, Takahiro; Takahashi, Ayumu; Takakuwa, Emi; Shinohara, Nobuo; Matsuno, Yoshihiro

Exacerbation of intimal fibrosis and endarteritis in a kidney transplant recipient with chronic active antibody-mediated rejection and COVID-19 : a case report

Otsuka, Takuya; Tanabe, Tatsu; Hotta, Kiyohiko et al.

Nephron, 2023, 147(Suppl. 1), 41-45

Permalink : https://hdl.handle.net/2115/93738

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アクセス権	open access
URI	https://hdl.handle.net/2115/93738
タイトル	Exacerbation of intimal fibrosis and endarteritis in a kidney transplant recipient with chronic active antibody-mediated rejection and COVID-19 : a case report
著者	Otsuka, Takuya ; Tanabe, Tatsu ; Hotta, Kiyohiko ; Iwasaki, Sari ; Tsuji, Takahiro ; Takahashi, Ayumu ; Takakuwa, Emi ; Shinohara, Nobuo ; Matsuno, Yoshihiro
著者名 Otsuka, Takuya
著者名 Tanabe, Tatsu
著者名 Hotta, Kiyohiko
著者名 Iwasaki, Sari
著者名 Tsuji, Takahiro
著者名 Takahashi, Ayumu
著者名 Takakuwa, Emi
e-Rad_Researcher 90250422 著者名 Shinohara, Nobuo
e-Rad_Researcher 00199829 著者名 Matsuno, Yoshihiro
言語	英語
キーワード	Chronic active antibody-mediated rejection
	Coronavirus disease 2019
	Endothelial cell injury
	Intimal fibrosis
	Kidney transplantation
発行日	2023-11
出版者	Karger
収録物名	Nephron
巻(号)	147(Suppl. 1)
ページ	41-45
抄録	Kidney transplant recipients are immunocompromised hosts at risk for comorbidity and mortality due to infection. Currently, there are no established guidelines for the management of immunosuppressed transplant recipients with coronavirus disease 2019 (COVID-19). The impact of COVID-19 and its therapeutic management on chronic active antibody-mediated rejection (CAAMR) are still unclear. Here, we report a case of CAAMR exacerbation with endarteritis and intimal fibrosis after COVID-19. A 41-year-old female kidney transplant recipient with CAAMR was admitted to a local hospital with moderately severe COVID-19. Her doses of tacrolimus and mycophenolate mofetil were reduced, and she was administered methylprednisolone pulse and antiviral drugs. This resulted in a good clinical course and she was discharged in 15 days. During and after hospitalization, the immunosuppressants were gradually returned to the baseline levels. However, about 1.5 months after discharge, the serum creatinine level became elevated. An indication kidney biopsy showed CAAMR with intimal fibrosis and endarteritis in all interlobular arteries. An increase of immunosuppressant led to a decrease of the serum creatinine level. Factors contributing to CAAMR with intimal fibrosis and endarteritis may include (1) insufficient immunosuppression due to changes in the levels of immunosuppressive; (2) overlap with endothelial cell injury caused by COVID-19, and (3) an immune-activated state associated with COVID-19. COVID-19 is a life-threatening disease that can result in unexpected changes in immunological status. Possible allograft rejection should be carefully managed in such patients.
資源タイプ	学術雑誌論文
出版タイプ	Accepted Manuscript
権利情報	This is the peer-reviewed but unedited manuscript version of the following article: Nephron 2023:147 Suppl 1:41-45 doi:10.1159/000531281. The final, published version is available at http://www.karger.com/?doi=10.1159/000531281.
PISSN	1660-8151
関連情報 (isVersionOf)	出版社版DOI https://doi.org/10.1159/000531281