SUCCESSFUL RENAL-TRANSPLANTATION IN A PATIENT WITH LARGE GRANULAR LYMPHOCYTIC-LEUKEMIA WITH NATURAL-KILLER-CELL PROLIFERATION

A patient with advancing renal failure attributed to focal segmental g lomerulosclerosis was found to have marked NK (CD56+) cell expansion a nd large granular lymphocytic leukemia. Subsequent living-related rena l transplantation was accomplished with two early bouts of acute cellu lar rejection requiring therapy with methylprednisolone and monoclonal antibody OKT3. Chronic triple drug immunosuppressive therapy has subs tantially reduced the marked NK (CD56+) proliferation. The renal trans plantation remains successful after 15 months despite persistent but r educed numbers of circulating NK cells, the potential role of which in the pathogenesis of the underlying nephropathy or the cellular reject ion process remains speculative.