Acute graft loss secondary to necrotizing vasculitis

Evidence for cytokine-mediated Shwartzman reaction in clinical kidney transplantation

George W Burke, R. Cirocco, M. Markou, A. Viciana, Phillip Ruiz, M. Allouch, V. Esquenazi, David Roth, J. Nery, J. Miller

Research output: Contribution to journalArticle

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Abstract

A small number of kidney transplant recipients abruptly lose function secondary to acute renal artery or vein thrombosis or more rarely a form of necrotizing vasculitis. We report a group of four kidney transplant recipients who lost renal function and share the following features: (1) diabetes (type I, insulin-dependent diabetes mellitus, type II or steroid- induced); (2) abrupt change/loss of renal function; (3) a concomitant clinical event (fever, viral symptoms, menometrorrhagia, viremia, bacteremia); (4) severe necrotizing vasculitis with hemorrhagic necrosis on histopathology; (5) patent renal artery and vein at time of transplant nephrectomy (i.e., no vascular thrombosis); and (6) high levels of peripheral serum γ-IFN 1-5 days before transplant nephrectomy (467 ± 175 pg/ml) compared with that of patients experiencing severe rejection (8.4 ± 3.7 pg/ml) (P<0.002). These data support the concept of a cytokine (IFN-γ)- mediated accelerated inflammatory response resulting in graft loss from necrotizing vasculitis-the clinical equivalent of an organ-specific Shwartzman reaction.

Original languageEnglish
Pages (from-to)1100-1104
Number of pages5
JournalTransplantation
Volume59
Issue number8
StatePublished - Jan 1 1995

Fingerprint

Shwartzman Phenomenon
Vasculitis
Kidney Transplantation
Cytokines
Transplants
Kidney
Renal Veins
Renal Artery
Nephrectomy
Type 1 Diabetes Mellitus
Thrombosis
Schoenlein-Henoch Purpura
Viremia
Bacteremia
Blood Vessels
Fever
Necrosis
Steroids
Serum

ASJC Scopus subject areas

  • Immunology
  • Transplantation

Cite this

Acute graft loss secondary to necrotizing vasculitis : Evidence for cytokine-mediated Shwartzman reaction in clinical kidney transplantation. / Burke, George W; Cirocco, R.; Markou, M.; Viciana, A.; Ruiz, Phillip; Allouch, M.; Esquenazi, V.; Roth, David; Nery, J.; Miller, J.

In: Transplantation, Vol. 59, No. 8, 01.01.1995, p. 1100-1104.

Research output: Contribution to journalArticle

Burke, GW, Cirocco, R, Markou, M, Viciana, A, Ruiz, P, Allouch, M, Esquenazi, V, Roth, D, Nery, J & Miller, J 1995, 'Acute graft loss secondary to necrotizing vasculitis: Evidence for cytokine-mediated Shwartzman reaction in clinical kidney transplantation', Transplantation, vol. 59, no. 8, pp. 1100-1104.
Burke, George W ; Cirocco, R. ; Markou, M. ; Viciana, A. ; Ruiz, Phillip ; Allouch, M. ; Esquenazi, V. ; Roth, David ; Nery, J. ; Miller, J. / Acute graft loss secondary to necrotizing vasculitis : Evidence for cytokine-mediated Shwartzman reaction in clinical kidney transplantation. In: Transplantation. 1995 ; Vol. 59, No. 8. pp. 1100-1104.
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