A 39-year-old male who received living kidney from his 62-year-old father, blood group matched and CDC cross match all negative, having acute cell mediated rejection 5 hours after transplant due to low Tacrolimus Trough level: A case report
1 Professor and Head, Consultant Physician, Department of Medicine, Defence Services Medical Academy, Yangon, Myanmar.
2 Head of Department, Department of Nephrology, No. (1) Defence Services General Hospital (1000-Bedded), Yangon, Myanmar.
3 Consultant Nephrologist, Department of Nephrology, No. (2) Defence Services General Hospital (1000-Bedded), Nay Pyi Taw, Myanmar.
4 Consultant Physician, Department of Medicine, No. (2) Defence Services General Hospital (1000-Bedded), Nay Pyi Taw, Myanmar.
5 Intensivist, Intensive Care Unit, No. (1) Defence Services General Hospital (1000-Bedded), Yangon, Myanmar.
6 Nephrology Fellow, Department of Nephrology, No. (2) Defence Services General Hospital (1000-Bedded), Nay Pyi Taw, Myanmar.
7 Consultant Radiologist, Department of Radiology, No. (2) Defence Services General Hospital (1000-Bedded), Nay Pyi Taw, Myanmar.
8 Consultant Pharmacologist, Department of Pharmacology, Defence Services Medical Academy, Yangon, Myanmar.
9 Consultant Pathologist, Department of Pathology, Defence Services Medical Academy, Yangon, Myanmar.
Case Study
GSC Biological and Pharmaceutical Sciences, 2022, 19(01), 317–325.
Article DOI: 10.30574/gscbps.2022.19.1.0168
Publication history:
Received on 19 March 2022; revised on 29 April 2022; accepted on 01 May 2022
Abstract:
A young renal transplant recipient received living kidney from his father; the Complement Dependent Cytotoxicity (CDC) cross match was all negative. He had oliguria 5 hours after transplant with fever and neutrophil leukocytosis. Doppler ultrasonogram revealed increased cortical echo with increased Resistive Index suggesting acute rejection or acute tubular necrosis. Renal transplant biopsy revealed acute T cell mediated rejection (acute TCMR) Grade IIA. Trough level of Tacrolimus blood level done on Day 5 was very low; therefore, Tacrolimus dose was increased. Therapeutic level achieved after giving 6 mg twice a day with addition of erythromycin. Escalating antibiotics, increasing steroids and Tacrolimus dose saved the transplant kidney.
Keywords:
Renal Transplant Recipient; Living Kidney; Resistive Index; Cell Mediated Rejection
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