An ABO‐incompatible renal transplant patient who developed severe antibody‐mediated vascular rejection 36 days after transplantation

Abstract

Abstract: A 44‐yr‐old man had an ABO‐incompatible renal transplantation from his 41‐yr‐old wife. He was diagnosed with IgA nephropathy at the age of 31 and began hemodialysis to treat chronic renal failure at the age of 39. Preoperative flow panel reactive antibody was negative. An episode biopsy on post‐operative day (POD) 18 showed mild infiltrative vasculopathy (v1, g2, ptc1, TMA, PTC+). The serum creatinine (sCr) was 2.26 mg/dL. Anti‐A antibody was x32. Double filtration plasmapheresis and plasma exchange were performed. A second episode biopsy was performed on POD 36. The Cr was 3.73 mg/dL. Anti‐A antibody was x32. Histologically, antibody‐mediated vascular rejection with severe fibrinoid necrosis in the lobular arteries was detected (v3, g2, ptc2, TMA, PTC+). Steroid pulse therapy was performed, and OKT‐3 was administered for 10 d. The anti‐A antibody titer was x128 on POD 47. A biopsy specimen obtained on POD 55 showed severe vascular rejection with stenosis of the vascular lumen and fibrinoid necrosis (v3, cv2, g1, cg2, ptc1, TMA, PTC+). The sCr was 7.09 mg/dL. Despite double‐filtration plasmapheresis, the patient was reintroduced to hemodialysis. Here, we report a case showing the typical histological features of antibody‐mediated vascular rejection.