Osorio-Contla EI, Rodríguez-Cuellar C, Rojas-Marauri CM, Zaltzman-Girshevich S, Bojórquez-Ochoa A, Reyes-Morales L, Cortés-Núñez X, Manrique D, Sabillón D, Navarro C

Language: Spanish
References: 12
Page: 99-103
PDF size: 254.17 Kb.

ABSTRACT

Acute renal transplant rejection is one of the causes of delayed graft function. Risk factors for this complication include, prolonged cold and warm ischemia time, intraoperative complications, and immunological incompatibility between donor and recipient. The presence of acute rejection negatively affects graft survival and necessitates timely diagnosis and treatment. Also, steroid-resistant or refractory rejection may have a worse outcome when compared to steroid-responsive rejection. The best treatment protocol for refractory rejection is unknown. Material and methods: This was a retrospective case review with a critical appraisal of the existing evidence from the literature. Results: We present the clinical case of a patient receiving a cadaveric renal transplant on induction therapy with methylprednisolone, basiliximab, cyclophosphamide and after that, with tacrolimus, prednisone and mycophenolate mofetil. The patient demonstrated delayed graft function with suspected acute mixed cellular and humoral rejection that proved to be resistant to oral corticosteroids. Subsequent treatment with intravenous methylprednisolone, plasmapheresis, IV immunoglobulin, and rituximab eventually resulted in recovery of renal function. The estimated GFR of the patient one year pot-transplantation was 80 mL/min/1.73 m²SC. The literature review provided little high-level evidence for the best approach to this complication. Conclusion: Aggressive therapy may result in reasonable one-year allograft survival. However, the best treatment for steroid-resistant acute rejection in grafts with delayed graft function remains to be established.

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