Author/Authors :
Khan, Taqi Toufeeq Riyadh Military Hospital - Department of Renal Transplant Surgery, Saudi Arabia , Mirza, Anzar Baig Riyadh Military Hospital - Department of Renal Transplant Surgery, Saudi Arabia , Zahid, Rafat Riyadh Military Hospital - Department of Renal Transplant Surgery, Saudi Arabia , Haleem, Abdul Riyadh Military Hospital - Department of Pathology, Saudi Arabia , Al Hussaini, Hussa Riyadh Military Hospital - Department of Pathology, Saudi Arabia , Al Sulaiman, Mohammad Riyadh Military Hospital - Department of Nephrology, Saudi Arabia , Mousa, Dujana Riyadh Military Hospital - Department of Nephrology, Saudi Arabia
Abstract :
We report the importance of elevated serum lactate dehydrogenase (LDH) and neutrophilia (NT) in two renal transplant recipients who developed renal impairment in the early post-operative period. One of our recipients developed oliguria and increased serum creatinine with unexplained elevation of LDH and NT. The biopsy was C4d positive with platelet and fibrin thrombi in the glomerular capillaries and arterioles and interpreted as acute vasculitis or thrombotic form of antibody-mediated rejection (VAMR) with positive donor-specific antibodies (DSA). Despite intensive treatment,this graft was lost. When another patient developed a similar picture,prompt immunoadsorption was started without waiting for a confirmatory biopsy or DSA,and both were later reported as positive. Improvement in renal function was associated with decreasing levels of LDH and NT. Neither of these was elevated in cases of acute cellular rejection (ACR) or antibody mediated rejection (AMR) with isolated tubular injury (TAMR). It may therefore be reasonable to assume that LDH and NT are potential diagnostic and prognostic markers of VAMR.
