RAJEEV SHARMA, AİDAS J MATTİS, AYOOLA ADEKİLE
Experimental and Clinical Transplantation - 2022;20(1):91-93
A 40-year-old male patient with a pretransplant calculated panel reactive antibody of 0 and no prior sensitizing events developed mixed active antibodymediated rejection and acute cellular rejection (Banff grade 1A) 1.5 years posttransplant. Testing for donorspecific antibody or non-human leukocyte antigen antibody (major histocompatibility complex class I chain-related antigen A/angiotensin II type I receptor) was negative. Biopsy demonstrated diffuse C4d staining in peritubular capillaries. The patient was treated with standard of care, including plasma - pheresis and intravenous immunoglobulin along with steroids, with return of renal function to baseline. However, 1 year after treatment, he developed chronic active antibody-mediated rejection without any donor-specific antibodies. We believe he did have smoldering antibody-mediated rejection that had progressed to a more chronic state over time. He was then treated with tocilizumab and had a successful return of serum creatinine to baseline. One year after treatment, he still has stable renal function, suggesting a role of tocilizumab in stabilizing renal function in patients with chronic active antibody-mediated rejection for which there is no Food and Drug Administration-approved treatment.
