Korean J Med.  2014 Feb;86(2):237-241.

A Case of Delayed Recovery from Antibody-Mediated Rejection

• Cho HJ
• Shin EH
• Yang YJ
• Jung JW
• Ji WJ
• Choi YK
• Park SK

Abstract

Antibody-mediated rejection (ABMR) in kidney transplant recipients is mediated by donor-specific antibodies. It is the major cause of graft failure in noncompliant patients and is associated with reduced long-term graft survival. We present a case of delayed recovery of renal function despite aggressive therapy after acute ABMR. A 49-year-old male on triple-drug maintenance immunosuppression (prednisolone, cyclosporine, and azathioprine), who underwent cadaveric donor renal transplantation 14 years earlier, visited our clinic with a serum creatinine level (SCr) of 1.9 mg/dL. The kidney biopsy revealed acute ABMR with diffuse C4d immunopositivity. We started steroid pulse therapy and bortezomib with plasmapheresis. Nevertheless, the SCr increased. Consequently, antithymocyte globulin (ATG) and intravenous immunoglobulin were administered. The SCr increased further to 4.1 mg/dL. Therefore, we performed a second kidney biopsy, which showed no change. Finally, we used rituximab. Fortunately, the SCr decreased gradually and returned to baseline.

Keyword

Kidney transplantation; Graft rejection; Medication adherence

MeSH Terms

Antibodies
Antilymphocyte Serum
Biopsy
Cadaver
Creatinine
Cyclosporine
Graft Rejection
Graft Survival
Humans
Immunoglobulins
Immunosuppression
Kidney
Kidney Transplantation
Male
Medication Adherence
Middle Aged
Plasmapheresis
Tissue Donors
Transplantation
Transplants
Bortezomib
Rituximab
Antibodies
Antilymphocyte Serum
Creatinine
Cyclosporine
Immunoglobulins