J Korean Soc Transplant.  2014 Sep;28(3):165-168. 10.4285/jkstn.2014.28.3.165.

Recovery of Delayed Graft Function after Calcineurin Inhibitor Sparing Regimen in a Renal Transplant Patient with Calcineurin Inhibitor Toxicity: A Case Report

• Kang SH
• Yun WS
• Cho KH
• Do JY
• Yoon KW
• Park JW

• KMID: 1727521
• DOI: http://doi.org/10.4285/jkstn.2014.28.3.165

Abstract

The recipient candidate was a 51-year-old male with end-stage renal disease owing to diabetes mellitus. The initial immunosuppressive regimen included basiliximab for induction and tacrolimus, mycophenolate mofetil, and steroids. Urine output was 413 mL/day on the operative day and 100 mL/day on the postoperative day (POD) 1. There was no definite stenosis of the ureter or vessels. He had anuria on POD 2~4 and he had undergone hemodialysis. His serum creatinine level did not decrease. Therefore, a graft biopsy was performed on POD 4. The pathologic finding was consistent with acute calcineurin inhibitor (CNI) toxicity. There was no evidence of rejection or acute tubular necrosis. Anuria continued on POD 6; therefore, we started sirolimus instead of a CNI based regimen. Graft function was gradually recovered 1 day after reduction of CNI dose and hemodialysis was stopped. The serum creatinine level was normalized on POD 10. He was discharged on POD 21.

Keyword

Calcineurin inhibitor; Sirolimus; Delayed graft function; Kidney transplantation

MeSH Terms

Anuria
Biopsy
Calcineurin*
Constriction, Pathologic
Creatinine
Delayed Graft Function*
Diabetes Mellitus
Humans
Kidney Failure, Chronic
Kidney Transplantation
Male
Middle Aged
Necrosis
Renal Dialysis
Sirolimus
Steroids
Tacrolimus
Transplants
Ureter
Calcineurin
Creatinine
Sirolimus
Steroids
Tacrolimus

Figure

• 

  Fig. 1. Course of urine output and serum creainine levels according to treatment. Abbreviations: KT, kidney transplantation; POD, postoperative day; CNI, calcineurin inhibitor; MPD, methylpred-nisolone; PD, prednisolone; MMF, mycophenolate mofetil; FK, tacrolimus; TL, trough level; SRL, sirolimus.

• 

  Fig. 2. (A∼ C) Initial light microscopy shows acute calcineurin inhibitor toxicity; this finding showed improvement at follow-up biopsy (D) (HE stain, ×800 for A and D; ×400 for B and C).

Reference

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