Late acute antibody mediated rejection after nine years of renal transplantation

Abstract EN

Acute Antibody Mediated Rejection (AMR) is rarely reported as a long-term complication of renal transplantation, and it can present on top of another chronic pathology affecting the graft.

A 45-year-old gentleman with chronic kidney disease due to unknown etiology received renal transplantation from his sister with 4 HLA mismatches.

He received antithymocte globulin induction therapy and was maintained on steroids, azathioprine (AZA) and cyclosporine A (CsA).

Up to eight years post-transplantation he was clinically and biochemically stable.

He lost followup for about one year, and then presented with nephritic nephrotic syndrome and rise of serum creatinine (SCr.) to 210 ?mol/L.

Graft biopsy revealed picture suggestive of acute AMR on top of de novo membranoprolipherative glomerulonephritis (MPGN) with focal crescent formation, diffuse immune complex deposition and peri-tubular capillaries C4d positivity.

Anti-HLA donor specific antibodies were highly positive for B and T cells class I and class II.

The patient was treated with intravenous immunoglobulin, plasma exchange and anti-CD20 (rituximab).

AZA was changed to mycophenolate mofetil and CsA to tacrolimus.

He had partial response, but SCr.

continued at 220 ?mol/L.