Acute graft loss secondary to necrotizing vasculitis: Evidence for cytokine-mediated shwartzman reaction in clinical kidney transplantation

George W. Burke, Robert Cirocco, Mike Markou, Ana Viciana, Phillip Ruiz, Mustafa Allouch, Violet Esquenazi, David Roth, Jose Nery, Joshua Miller

Research output: Contribution to journalArticle

4 Scopus citations

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 (US)
Pages (from-to)1100-1104
Number of pages5
JournalTransplantation
Volume59
Issue number8
DOIs
StatePublished - Apr 27 1995

ASJC Scopus subject areas

  • Transplantation

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