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Acute cellular rejection in a renal allograft immediately following leukocyte engraftment after auto-SCT

Bone Marrow Transplantation volume 43, pages 345–346 (2009)Cite this article

As the list of diseases treated with auto-ASCT grows, it is inevitable that patients with a solid organ transplant will undergo auto-SCT. In immunoglobulin light chain (AL) amyloidosis, auto-SCT is performed in combination with kidney transplantation in those who developed end-stage kidney disease.1 The management of immunosuppression immediately after auto-SCT can be difficult as overimmunosuppression raises the risk of infection, whereas underimmunosuppression may result in acute rejection. We present a case to illustrate the complexity of this management.

A previously healthy 58-year-old man presented with fatigue, anemia and a serum creatinine (Scr) level of 4.5 mg/100 ml. A monoclonal lambda light chain was identified in the blood and urine, and the bone marrow showed 11% lambda-restricted plasma cells. Renal biopsy confirmed the diagnosis of AL amyloidosis. After 4 months, he was started on hemodialysis. With no evidence of cardiac or hepatic involvement, a living unrelated donor kidney transplantation (Ktx) followed by auto-SCT was planned. His wife (0 of 6 antigen match) was selected as the donor.

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References

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic Rochester, Rochester, MN, USA

    N Leung & J M Gloor

  2. Department of Transplant Surgery, Mayo Clinic Rochester, Rochester, MN, USA

    P G Dean

  3. Department of Internal Medicine, Division of Hematology, Mayo Clinic Rochester, Rochester, MN, USA

    M Q Lacy & L F Porrata

  4. Regenerative Medical Institute, National University of Ireland, Galway, Ireland

    M D Griffin

Authors
  1. N Leung
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  2. J M Gloor
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  3. P G Dean
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  4. M Q Lacy
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  5. L F Porrata
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  6. M D Griffin
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Correspondence to N Leung.

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Leung, N., Gloor, J., Dean, P. et al. Acute cellular rejection in a renal allograft immediately following leukocyte engraftment after auto-SCT. Bone Marrow Transplant 43, 345–346 (2009). https://doi.org/10.1038/bmt.2008.320

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