Delayed Recovery of Accelerated Acute Rejection

Abstract

AbstractAccelerated acute rejection (AAR) after kidney transplantation may occur because of the pre‐sensitization of the host cell against the graft antigens. We report the case of a 49‐year‐old female, under chronic hemodialysis therapy who received a living transplant from her husband. Both of them had the same blood type and the result of the mixed lymphocyte culture test was acceptable before transplantation. The operation was smooth and a combination therapy with cyclosporine, prednisolone, and mycophenolate mofetil (MMF) was given. However, oliguria developed on the second day after transplantation. After excluding the possibility of occlusive lesion, the first course of pulse steroid therapy was given under the impression of AAR, supported by renal biopsy. After the second course of pulse steroid and OKT3 therapy, her renal function did not recover. Thereafter, she received regular hemodialysis therapy and cyclosporine was replaced by tacrolimus. Two months later, her urine amount increased dramatically. The renal biopsy revealed changes of interstitial cells infiltration without acute rejection. The patient's serum creatinine level declined to 1.76 mg/dl 6 months later, and was maintained at around 1.1 mg/dl after 4.5 years. This is a demonstration of a delayed recovery of AAR combined with the suspicion of cyclosporine‐related nephrotoxicity. Protocol repeated biopsies may be required in those patients who do not recover after an initial rejection to detect early second pathologies.