Open AccessThe gray area between operational tolerance and overt rejection in kidney transplantation
Author(s) -
Rui Silva,
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Miguel Relvas,
Aunes,
José Silvano,
Ana Beco,
Manuela Bustorff,
Susana Sampaio,
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AUTHOR_ID,
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Publication year - 2022
Publication title -
revista portuguesa de nefrologia e hipertensão
Language(s) - English
Resource type - Journals
eISSN - 2183-1289
pISSN - 0872-0169
DOI - 10.32932/pjnh.2021.12.162
Subject(s) - medicine , immunosuppression , creatinine , subclinical infection , kidney transplantation , transplantation , proteinuria , urology , immunology , kidney , gastroenterology , intensive care medicine
Operational tolerance in kidney transplantation is characterized by stable serum creatinine < 1.7 mg/dL and proteinuria < 1 g/day in the absence of immunosuppression or immunodeficiency for over one year. However, simultaneous donor specific antibodies are common and serum creatinine is a poor surrogate of early lesions. Consequently, subclinical rejections will meet operational tolerance criteria if serum creatinine remains stable. We report a patient with operational tolerance criteria followed by biopsy-proven chronic active antibody mediated rejection, discussing the intricate challenges of immunosuppression management.