Abstract
Rejection is the major cause of graft failure, and if the injury to the tubules and glomeruli is severe, the kidney may not be recovered. It is therefore important to diagnose acute rejection as soon as possible to institute rescue therapy. PRA (panel reactive antibody) tests before and after the transplant, is used as a method to gauge whether or not cross-reactivity. High PRA means a likelihood of acute rejection and the recipient of high PRA is needed for adequate pretreatment for kidney transplantation but in cadaveric kidney transplant there is no sufficient time and chance to desensitization. We report a successful renal transplant outcome in a 47-yr-old-woman with high PRA levels (class I 97.5%, class II 36.7%). The cross match was negative on CDC(ELISA) and flowcytometric method. Plasma exchange was performed on recipient before transplantation (fresh frozen plasma replacement, 1.3 plasma volume) and immediately after plasma exchange she was given rituximab 200mg. She received basiliximab and methyl prednisolone induction therapy and was maintained on steroids, mycophenolate mofetil and tacrolimus. Graft function was normal immediately after transplantation but decreased urinary output and elevated serum creatinine was noted on POD 5. She was underwent hemodialysis four times. Renal biopsy was performed on POD 6. Graft biopsy revealed acute cellular rejection (type IIa) simultaneous with antibody mediated rejection (type III). On 9 - 13 days after transplantation, plasma exchange (fresh frozen plasma replacement, 1.3 plasma volume) once every other day and steroid pulse therapy was performed 3 times. After the normalization of urinary output and serum creatinine, the patient was discharged and currently being follow-up. In conclusion, immunologically careful preparation and pretransplant treatment may be needed on the negative cross match in cadaveric kidney recipient of high levels of PRA.
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