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KMID : 0882420140860020237
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Korean Journal of Medicine
2014 Volume.86 No. 2 p.237 ~ p.241
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A Case of Delayed Recovery from Antibody-Mediated Rejection
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Cho Hyung-Jin
Shin Eun-Hye
Yang Young-Joo
Jung Ji-Won
Choi Young-Kwon
Park Su-Kil
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Abstract
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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.
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KEYWORD
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Kidney transplantation, Graft rejection, Medication adherence
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