A CASE REPORT OF IMMUNOSUPRESSION RELATED COMPLICATIONS IN A KIDNEY TRANSPLANTED PATIENT

  • Adrijana Spasovska Vasilova University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Sanja Trajkova University Clinic of Hematology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Elena Simonovska University Clinic for Pediatric Diseases, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Simona Stojanoska Godjoska Institute of Pathology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Ana Stojanoska University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Igor Nikolov University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Irena Rambabova Bushljetik University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Lada Trajcheska University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia
  • Goce Spasovski University Clinic of Nephrology, "Ss. Cyril and Methodius" University, Faculty of Medicine, Skopje, Republic of North Macedonia

Abstract

Immunosuppressed transplant recipients have a higher rate of prolonged survival with a functioning graft, but also prolonged exposure to complications of chronic immunosuppression. Registry data found cancer to be the third most common cause of death after cardiovascular accidents and infections in these patients. In the following case, we present a kidney transplanted patient, successfully treated for Diffuse large B-cell lymphoma, generalized Herpes Zoster, and CMV infection. The patient was a 60 years-old man with a kidney transplant from a cadaver 5 years ago. After the transplantation, no complications occurred. He regularly referred for medical monitoring, and was adherent to medical treatment and investigations. His long term immunosuppressive therapy consisted of a low dose of corticosteroids, tacrolimus, and mycophenolic acid. The patient presented with acute pain and tenderness all over the abdomen that lasted for a few hours. After CT imagining confirmed intussusception at left colic flexure, urgent surgery was performed. Tissue sampling diagnosed Large B-cell lymphoma. The patient underwent 4 cycles of dose-rationalized R-CHOP therapy with a normal PET scan afterward. Herpes Zoster generalized infection and CMV occurred in two months. Treatment with acyclovir was successful. The regular immunosuppressive regime was re-introduced, consisting only of corticosteroids and sirolimus. The creatinine level remained stable for the next two years, and all subsequent PET scans and CT images were in normal range. The patient remained free of infections as well.


Key wordskidney, transplant, immunosuppression, B-cell lymphoma, malignicy.

References

1. Raffaele Girlanda (22 May, 2013). Complications of Post-Transplant Immunosuppression, Regenerative
Medicine and Tissue Engineering, Jose A. Andrades, IntechOpen, DOI: 10.5772/55614. Available from:
https://www.intechopen.com/books/regenerative-medicine-and-tissue-engineering/complications-of-post-
transplant-immunosuppression
2. Wimmer CD, Rentxch M, Crispin A. The Janus face of immunosuppression – de novo malignancy after renal
transplantation; the experience of the Transplantation Center Munich. Kidney Int 2007;71; 1271-8
3. Excerpts from the United States Renal Data System 2008 Annual data report. Transplantation. Am J Kidney Dis
2009; 53 (1):228-38
4. Sprangers B, Nair V, Launay-Vacher V, Riella LV, Jhaveri KD. Risk factors associated with post-kidney transplant
malignancies: an article from the Cancer-Kidney International Network. Clin Kidney J. 2018;11(3):315-29.
doi:10.1093/ckj/sfx122.
5. Hong J, Suh C, and Kim W. Evolution of frontline treatment of diffusive large B-cell lymphoma: time for
precision medicine approach. Hematology 2015; 1:618-24.
6. Preikasaitis JK, Cockfield SM. Epstein-Barr virus infection and lymphoproliferative disease after hematopoietic
stem cell or solid organ transplantation. In: Bowden RA, Ljungman P, Paya CV, et al, eds. Transplant Infections.
2nd Edition. Lippincott Williams & Wilkins, 2003:326-49.
7. Hezode C, Duvoux C, Germanidis G, et al. Role of hepatitis C virus in lymphoproliferative disorders after liver
transplantation. Hepatology. 1999;30:775-8.
8. Manez R, Breinig MC, Linden P, et al. Post-transplant lymphoproliferative disease in primary Epstein-Barr
virus infection after liver transplantation: the role of cytomegalovirus disease. J. Infect. Dis. 1997;176:1462-7.
9. Walker RC, Marshall WF, Strickler JG, et al. Pretransplantation assessment of the risk of lymphoproliferative
disorder. Clin. Infect. Dis. 1995;20:1346-53.
10. Walker RC, Marshall WF, Strickler JG, et al. Pretransplantation assessment of the risk of lymphoproliferative
disorders. Blood. 2003;102:2775-3785.
11. Dror Y, Greenberg M, Taylor G, et al. Lymphoproliferative disorders after organ transplantation in children.
Transplantation. 1999;67:990-8.
12. Shapiro R, Nalesnik M, McCauley J, et al. Posttransplant lymphoproliferative disorders in adult and pediatric
renal transplant patients receiving tacrolimus-based immunosuppression. Transplantation. 1999;68:1851-4.
13. Opelz G, Dohler B. Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J
Transpl. 2003;4:222-30.
14. Snanoudj R, Durrbach A, Leblond V, et al. Primary brain lymphomas after kidney transplantation:
presentation and outcome. Transplantation. 2003;76(6):930-37. doi:10.1097/01.TP.0000079253.06061.52
15. Leblanc KG Jr, Hughes MP, Sheehan DJ. The role of sirolimus in the prevention of cutaneous squamous cell
carcinoma in organ transplant recipients. Dermatol Surg. 2011; 37(6):744-9.
16. den Akker JMH-v, Harden PN, Hoitsma AJ, Proby CM, Wolterbeek R, Bouwes Bavinck JN, et al. Two-year
randomized controlled prospective trial converting treatment of stable renal transplant recipients with
cutaneous invasive squamous cell carcinomas to sirolimus. J. Clin. Oncol. 2013;31:1317–23. DOI: 10.
1200/JCO.2012.45.6376.
Published
2020-07-06
How to Cite
SPASOVSKA VASILOVA, Adrijana et al. A CASE REPORT OF IMMUNOSUPRESSION RELATED COMPLICATIONS IN A KIDNEY TRANSPLANTED PATIENT. Journal of Morphological Sciences, [S.l.], v. 3, n. 2, p. 37-41, july 2020. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/128>. Date accessed: 28 mar. 2024.
Section
Articles