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Ultra‐Late Antibody‐Mediated Rejection 30 Years After a Living‐Related Renal Allograft
Author(s) -
Weinstein David,
Braun William E.,
Cook Daniel,
McMahon James T.,
Myles Jonathan,
Protiva Deborah
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.01044.x
Subject(s) - medicine , transplantation , azathioprine , peritubular capillaries , antibody , urology , tacrolimus , kidney transplantation , renal function , renal biopsy , gastroenterology , immunology , disease
Antibody‐mediated renal allograft rejection has become increasingly recognized and more clearly defined through the use of flow cytometry cross‐matching and the deposition of C4d in renal allograft biopsies. All of the cases reported thus far have developed an antibody within 10 years of transplantation, and many lacked HLA and/or donor specificity.The present patient developed an anti‐HLA donor‐specific antibody between the 22nd and 30th year after a living‐related renal transplant. At the 30th year post‐transplantation, she experienced a rise in the serum creatinine from 0.7 to 1.9 mg/dL associated with transplant biopsy C4d deposition in peritubular capillaries and glomeruli. After the replacement of azathioprine with mycophenolate mofetil, and six apheresis treatments followed by two infusions of IVIG, the renal function stabilized at 1.9 mg/dL, 33 years after transplantation. Antibody‐mediated rejection must be considered as a possible cause or renal allograft dysfunction at all time periods after transplantation.