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CEN Case Reports

, Volume 7, Issue 2, pp 288–291 | Cite as

Development of antibody mediated rejection shortly after acute cellular rejection in a pediatric kidney transplantation recipient

  • Mari Okada
  • Koichi Kamei
  • Kentaro Matsuoka
  • Shuichi Ito
Case Report
  • 44 Downloads

Abstract

Acute rejection is a major cause of graft loss in patients with kidney transplantations. However, the appropriate timing for performing a biopsy is often difficult to gauge in a clinical settings. We encountered an 8-year-old boy in whom antibody mediated rejection (AMR) associated with de novo donor-specific antibody (DSA) developed shortly after an episode of type IA acute cellular rejection (ACR). He had received a preemptive ABO-compatible kidney transplantation due to bilateral renal hypoplasia. Type IA ACR developed 2 months after transplantation and was successfully treated with methylprednisolone pulse therapy (MPT) and gusperimus hydrochloride. However, 4 months after transplantation, his serum creatinine level increased again. We decided to perform an additional biopsy despite having done the previous biopsy only a short time ago. Marked infiltration of inflammation cells in the peritubular capillaries (PTCs) with positive C4d staining was observed. AMR associated with de novo DSA with type IB ACR was newly diagnosed because DSA was not detected and the crossmatch test was negative before transplantation. He immediately received two courses of plasma exchange (PE), three courses of MPT, and rituximab. He confessed to non-adherence and underwent a patient education program with his family again. To date, no cases of AMR associated with de novo DSA shortly after ACR have been reported. Our experience lends support to the ‘episode biopsy’ method in which a biopsy is performed for each episode of serum creatinine increase as recommended by The Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Working Group.

Keywords

Kidney transplantation Antibody mediated rejection De novo donor-specific antibody 

Notes

Acknowledgements

The authors thank Dr. J. Tang from the Department of Education for Clinical Research, National Center for Child Health and Development, for his assistance with editing the manuscript.

Compliance with ethical standards

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from the patient included in this article.

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  1. 1.Department of PediatricsMusashino Red Cross HospitalMusashinoJapan
  2. 2.Division of Nephrology and RheumatologyNational Center for Child Health and DevelopmentTokyoJapan
  3. 3.Division of PathologyDokkyo Medical University Koshigaya HospitalKoshigayaJapan
  4. 4.Department of Pediatrics, Graduate School of MedicineYokohama City UniversityYokohamaJapan

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