대한신장학회

논문분류	춘계학술대회 초록집
제목	Treatment of Acute Rejection in HIV-infected Patients undergoing Kidney Transplantation
저자	Jin won JANG1, Keun-sang KWON2, *Sik LEE1, Kyung pyo KANG1, Won KIM1, Sung kwang PARK1, Jin han LIM1
출판정보	2017; 2017(1):
키워드	Acute rejection, Kidney transplantation, HIV, Steroid pulse therapy
초록	Case Study : Kidney transplantation (KT) is the treatment for end-stage renal disease in HIV-infected individuals. But acute rejection (AR) rates are over twice those of HIV-negative recipients. Therefore, in addition to antiretroviral treatment and immunosuppressive therapy, it becomes more important to find the most efficient treatment of acute rejection in HIV-infected recipient. Herein we have reported the two case of HIV–infected men who received a living kidney transplant and developed an acute rejection, which was successfully treated with steroid pulse therapy. Patient 1. A 33-year-old, HIV infected man received a living renal graft from father. He had a 5-year history of hypertension and 1-year history of AIDS. Flow cytometry crossmatch was negative and the panel reactive antibody (PRA) level was 0%. In the postoperative course, he took immunosuppressive drug, which was tacrolimus, mycophenolate mofetil(1g/day), prednisone. Also antiretroviral therapy included abacavir, raltegravir, lamivudine. On posttransplant-day (PTD) 21, serum creatinine (sCr) increased to 2.05mg/dL. renal Doppler evaluation showed hyperechogenic kidney, and a mildly elevated resistive index (RI = 0.8 – 0.9). Findings considered to be an acute rejection episode. Methylprednisolone boluses (500mg/day) was administered during the next 3 days. HIV viral load was < 20 copies/mL, CD4-161 cells/uL. The patient received tazobactam and piperacillin as infection prophylaxis. Also he maintained immunosuppressive drug and antiretroviral drug. On PTD 27, he was discharged with a sCr of 1.21 mg/mL, CD4- 673 cells/uL and uneventfully followed in the outpatient clinic for the following 45 months. Patient 2. A 42-year-old man received a living renal graft from his sister-in-law. He had a 13-year history of hypertension, 1-year history of AIDS and 1-year history of unstable angina. The HLA mismatch was 5/6 but flow cytometry crossmatch was negative and the PRA level was 0%. In the postoperative course, the immunosuppressive regimen included tacrolimus, mycophenolate mofetil(1g/day), prednisone as maintenance treatment. Also antiretroviral therapy included abacavir, raltegravir, lamivudine. On PTD 19, he was discharged with a sCr of 1.10 mg/mL. But on PTD 48, he visited our out-patient department with abdominal pain. sCr increased to 1.85mg/dL, and abdominal CT showed hematoma around graft kidney. We stopped anti-platelet agent, but sCr do not decreased. We considered to be an acute rejection episode. Methylprednisolone boluses (500mg/day) was administered during the next 3 days. HIV viral load was < 20 copies/mL, CD4-76 cells/uL. The patient received tazobactam and piperacillin as infection prophylaxis. Also he maintained immunosuppressive drug and antiretroviral drug. On PTD 64, he was discharged with a sCr of 1.48 mg/mL, CD4- 577 cells/uL. At the last medical visit, 16 months later, he had stable graft function with a sCr 1.08mg/dL. High risk of AR is a well-known concern in HIV-infected kidney graft recipients. In this report, we described the two case of HIV-infected kidney transplantation patient with acute rejection, which was successfully treated with steroid pulse therapy in addition to antiretroviral treatment and immunosuppressive therapy. So we suggested that steroid pulse therapy in addition to antiretroviral treatment and immunosuppressive therapy in an HIV patient with acute rejection was effective and safe.
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