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Annals of Clinical & Laboratory Science 34:209-213 (2004)
© 2004 Association of Clinical Scientists

Case Report

Monocyte-Mediated Acute Renal Rejection after Combined Treatment with Preoperative Campath-1H (Alemtuzumab) and Postoperative Immunosuppression

Ping L. Zhang1, Sayeed K. Malek2, Jeffery W. Prichard1, Fan Lin1, Taher M Yahya3, Michael S. Schwartzman3, Ruth P. Latsha2, Marybess Skaletsky2, Evan R. Norfolk3, Robert E. Brown1, James E. Hartle3 and Santosh Potdar2
1 Divisions of Laboratory Medicine, 2 Transplantation, and 3 Nephrology, Geisinger Medical Center, Danville, Pennsylvania

Address correspondence to Ping L. Zhang, MD, PhD, Dept. of Laboratory Medicine, Geisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, USA; tel 570 271 6333; fax 570 271 6105; e-mail: plzhang{at}geisinger.edu.

Abstract

Campath-1H (alemtuzumab), a humanized monoclonal antibody against CD52, can cause more profound depletion of lymphocytes than monocytes. The resultant imbalance of lymphocytes and monocytes after Campath-1H treatment of a renal-transplant recipient may lead to an acute rejection dominated by monocytes. We report such a case of acute transplant rejection in a 49-yr-old man who received a living non-related kidney transplant and was treated with preoperative Campath-1H and postoperative immunosuppression. An initial post-transplant renal biopsy showed diffuse mild acute rejection with 95% CD68-positive monocytes, but only 5% CD3-positive T lymphocytes. Inflammatory cells in the renal biopsy were negative for CD34 and CD1a stains, suggesting non-involvement of CD34-derived dendritic cells in the acute rejection. After steroid treatment for 2 wk, the patient’s serum creatinine concentration diminished to 1.5 mg/dl. The histopathological features of acute rejection were absent in a second biopsy of the transplanted kidney. In summary, this case is an instance of monocyte-mediated acute rejection of a transplanted kidney.

Keywords: Campath-1H, CD52, monocytes, acute transplant rejection, renal transplantion






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