TABLE 1.

Timeline of post‐transplant treatment events.

Timeline	Events
Operative day	Kidney transplantation; living relative as the donor
+9 days	US: 16 × 9 × 9 cm peri‐transplant fluid collection, lymphocele
+21 days	Renal biopsy: No evidence of rejection. Absence of DSA
+24 days	Laparoscopic peritoneal window
+32 days	US: Small amount ascites. Normal transplant kidney
+42 days	Renal biopsy: Moderate epithelial foot process effacement. No evidence of rejection. Absence of DSA Treated with steroids
+60 days	NM MAG3 scan: Negative for obstruction
+72 days	Renal biopsy: Intact epithelial foot process. No evidence of rejection VCUG: Normal Tacrolimus pharmacokinetic study: Normal
+163 days	Renal biopsy: ACR, Banff 1A. Negative C4d. Absence of DSA. Treated with ATG (1 mg/kg) and steroids
+194 days	Renal biopsy: Borderline for ACR. Tubular injury was characterized by isometric vacuoles and Tamm‐Horsfall (uromodulin) protein extravasation. Absence of DSA. dd‐cfDNA < 0.18% NM MAG3 scan: Prolonged cortical uptake in transplant kidney Cystogram and retrograde pyelogram: No evidence of obstruction Tacrolimus was switched to envarsus and everolimus, due to concern of CNI toxicity
+235 days	Renal biopsy: Acute tubular injury, which might be secondary to hypoperfusion or nephrotoxic etiologies
+285 days	COVID test: Positive.
+311 days	Absence of DSA. dd‐cfDNA < 0.08%
+339 days	Renal biopsy: borderline ACR Treated with steroids
+396 days	Conversion to Belatacept
+408 days	Urodynamic study: Normal VCUG: Normal
+410 days	Right ankle swelling. Lower extremity duplex US was negative for superficial or deep vein thrombosis
+444 days	Renal biopsy: ACR, Banff 1A Treated with steroids
+469 days	Influenza A infection
+479 days	Left leg swelling. Left popliteal, posterior tibial, peroneal and soleal vein thrombosis on Lower extremity duplex US Hypercoagulation panel: negative Treated with apixaban for 3 months
+542 days	Right inguinal hydrocele was diagnosed at outside hospital US: normal transplant kidney with patent vasculature
+573 days	Worsened proteinuria with development lower extremity edema despite normal albumin (4 g/dL) Treated with rituximab and IVIG infusion. Belatacept stopped. Converted to cyclosporine and mycophenolate mofetil
+651 days	Significant back pain with right groin and right leg swelling Outside doppler US: questionable lower extremity thrombosis and unremarkable allograft study CT venogram: extensive clot burden in the inferior iliac vein, bilateral iliac veins and transplant renal vein Thrombolysis with serial mechanical thrombectomy
+711 days	MRA: patent inferior vena cava, bilateral common iliac veins, bilateral external iliac veins, bilateral internal iliac veins and right transplant renal vein

Abbreviations: ACR, acute cellular rejection; ATG, Anti‐thymocyte globulin; CNI, calcineurin inhibitor; CT, Computed tomography; dd‐cfDNA, donor‐derived cell‐free deoxyribonucleic acid; DSA, donor specific antibody; IVIG, intravenous immunoglobulin; MRA, Magnetic resonance angiography; NM MAG3 scan, Nuclear medicine renal flow and function mercaptoacetyltriglycine scan; US, ultrasound; VCUG, voiding cystourethrogram.