C4d 100% Positive in Renal Biopsy of Patient with Acute Graft Dysfunction Successfully Managed with Bortezomib, Clinical Case
Luis R Lopez1, Mario A Cerecedo1, David Escamilla1, Rebeca Alvarez1, Jorge Rivera1, Veronica Bautista1, Michael E Wasung1, Mario A Sebastian md1, Roberto Vazquez1, Marco Carmona1.
1Nefrologia, Hospital Central Sur de Alta Especialidad ¨Picacho¨ Petróleos mexicanos, CDMX, , Mexico
Introduction: 57-year-old male patients with renal insufficiency secondary to hypertensive disease. It has as background medical hemotransfusion positive four globular units and reative panel of negative antibodies, zero%
Materials and Methods: The patient received renal transplantation from cadaveric donor, cold ischemia of 24 hours, delayed function of the graft requiring three sessions of hemodialysis. received induction treatment based on basiliximab 40 mg, methylprednisolone 3 grams, without surgical complications, his maintenance treatment was mycophenolate mofetil 500 mg three times a day, Cyclosporine 100 mg twice daily, cyclosporine (C0) concentration: 153 ng / mL, and 200 mg of prednisone daily that was subsequently tapered. The patient received antiviral prophylaxis consisted of 450 mg of acyclovir three times a week and trimethoprim-sulfamethoxazole 160/800 mg three times a week. The patient, two months after the transplant, presented lymphocele and was drained and sclerosed. The cratinin went to 1.5 mg%. Four months after the transplant, presented urinary tract infection without creatinin problems or sepsis, he was managed with ciprofloxacin 500 mg every 12 hours for 7 days. Subsequently, the patient presented elevated creatinine at 2.2 mg%, renal USG without obstructive data and it was decided to perform a renal graft biopsy.
Results: The diagnosis was kidney rejection mediated by antibodies with positive C4d in all the peritubular capillaries of the sample.
the treatment was methylprednisolone 3 gr, plasmapheresis three sessions of 1.5 volums treated on day 1, 3, 5, bortezomib (1.3 mg / m²) on days 1, 4, 8, and 11, rabbit antithymocyte globulin: (1.5mg / kg / day) on days 9, 10, 11. At discharge the serum creatinine fell to 1.7 mg%,
asymptomatic without infectious complaints.
Conclusions: Our patient had risk factors for antibody-mediated rejection, it was successfully managed with a complete scheme of inmusupresion, it is very important to give treatment in the different phases regarding the production of antibodies.
