Korean J Nephrol.  1999 Jan;18(1):204-209.

A Case of Myelodysplastic Syndrome in a Renal Transplant Recipient

• Lee CW
• Kang MS
• Kim JK
• Lee HA
• Chu WS
• Lee YK
• Kim WB
• Park MS
• Hwang SD
• Lee HB

Abstract

A 44-year-old man treated with azathioprine, cyclosporine and prednisolone for 7.5 years after allogeneic renal transplantation was admitted because of exertional dyspnea, fatigue and pancytopenia which were found 3 months ago. He had been on hemodialysis for renal failure of unknown cause for 8 months before the renal transplantation. Bone marrow examination showed hypercellularity, erythroid hyperplasia and 7% of myeloblast, consistent with the diagnosis of myelodysplastic syndrome. Cytogenetic study showed chromosomal abnormalities:deletion of chromosome 5, monosomy 7, trisomy 8, monosomy 14 and deletion of chromosome 17. Immunosuppressive agents were discontinued and he was treated with transfusion, G-CSF, and combination chemotherapy including topotecan and Ara-C. Graft kidney function was normal before and after the treatment, but the clinical course was fatal because of leukemic transformation and eventually sepsis. Although therapy induced myelodysplastic syndrome was rare in renal allograft recipients, thorough evaluations including bone marrow biopsy and cytogenetic study are recommended in patients with anemia of unknown etiology.

Keyword

Myelodysplastic Syndrome; Leukemic transformation; Renal transplantation; Immunosuppressive agents; chromosomal abnormality

MeSH Terms

Adult
Allografts
Anemia
Azathioprine
Biopsy
Bone Marrow
Bone Marrow Examination
Chromosome Aberrations
Chromosomes, Human, Pair 17
Chromosomes, Human, Pair 5
Cyclosporine
Cytarabine
Cytogenetics
Diagnosis
Drug Therapy, Combination
Dyspnea
Fatigue
Granulocyte Colony-Stimulating Factor
Granulocyte Precursor Cells
Humans
Hyperplasia
Immunosuppressive Agents
Kidney
Kidney Transplantation
Monosomy
Myelodysplastic Syndromes*
Pancytopenia
Prednisolone
Renal Dialysis
Renal Insufficiency
Sepsis
Topotecan
Transplantation*
Transplants
Trisomy
Azathioprine
Cyclosporine
Cytarabine
Granulocyte Colony-Stimulating Factor
Immunosuppressive Agents
Prednisolone
Topotecan