A case of pregnancy‐induced thrombotic thrombocytopenic purpura with a kidney allograft recipient

Iwami D, Harada H, Hotta K, Miura M, Seki T, Togashi M, Hirano T. A case of pregnancy‐induced thrombotic thrombocytopenic purpura with a kidney allograft recipient. Clin Transplant 2010: 24 (Suppl. 22): 66–69. © 2010 John Wiley & Sons A/S. : A 32‐yr‐old female patient, who had been suffering from diffuse crescentic glomerulonephritis and a consequent end‐stage renal disease, successfully underwent living‐related ABO‐incompatible kidney transplantation after a desensitization therapy including anti‐CD20 monoclonal antibody. Forty‐six months after the transplantation, the recipient became pregnant. At the 17th gestational week, the patient was admitted for the management of pregnancy‐induced hypertension and aggressive deterioration of kidney graft function. At the 21st gestational week, the patient lost her kidney graft and was re‐induced into regular hemodialysis. The patient was also suffering from progressive hemolytic anemia, thrombocytopenia, and neurologic symptoms with decreased activity of von Willebrand factor‐cleaving protease, a disintegrin‐like and metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13). From these findings and a kidney allograft biopsy, the patient was diagnosed as thrombotic thrombocytopenic purpura concurrent with acute T‐cell‐mediated rejection. The patient immediately underwent plasma exchange as well as steroid pulse therapy. Despite these treatments, thrombocytopenia and intrauterine growth retardation progressed. The patient underwent a caesarian section at the 24th gestational week. Consequently, her platelet count recovered drastically. However, the patient lost her neonate five d after giving a birth, and the patient’s graft function had never recovered.