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- Title
A case of pregnancy-induced thrombotic thrombocytopenic purpura with a kidney allograft recipient.
- Authors
Iwami, Daiki; Harada, Hiroshi; Hotta, Kiyohiko; Miura, Masayoshi; Seki, Toshimori; Togashi, Masaki; Hirano, Tetsuo
- Abstract
A 32-yr-old female patient, who had been suffering from diffuse crescentic glomerulonephritis and a consequent end-stage renal disease, successfully underwent living-related ABO-incompatible kidney transplantation after a desensitization therapy including anti-CD20 monoclonal antibody. Forty-six months after the transplantation, the recipient became pregnant. At the 17th gestational week, the patient was admitted for the management of pregnancy-induced hypertension and aggressive deterioration of kidney graft function. At the 21st gestational week, the patient lost her kidney graft and was re-induced into regular hemodialysis. The patient was also suffering from progressive hemolytic anemia, thrombocytopenia, and neurologic symptoms with decreased activity of von Willebrand factor-cleaving protease, a disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13). From these findings and a kidney allograft biopsy, the patient was diagnosed as thrombotic thrombocytopenic purpura concurrent with acute T-cell-mediated rejection. The patient immediately underwent plasma exchange as well as steroid pulse therapy. Despite these treatments, thrombocytopenia and intrauterine growth retardation progressed. The patient underwent a caesarian section at the 24th gestational week. Consequently, her platelet count recovered drastically. However, the patient lost her neonate five d after giving a birth, and the patient's graft function had never recovered.
- Publication
Clinical transplantation, 2010, Vol 24 Suppl 22, p66
- ISSN
1399-0012
- Publication type
Journal Article
- DOI
10.1111/j.1399-0012.2010.01272.x