Table 2.
Clinical data of the recurrent disease
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | |
|---|---|---|---|---|
| Age at transplant | 57 | 62 | 75 | 40 |
| Kidney source | Living-unrelated donor | Deceased donor | Living-related donor | Living-unrelated donor |
| HLA mismatch | 4 of 6 HLA antigens | 0 of 6 HLA antigens | 2 of 6 HLA antigens | 4 of 6 HLA antigens |
| Percent PRAa | 1% for class I | 0% for class I | 0% for class I | 0% for class I |
| 13% for class II | 0% for class II | 0% for class II | 0% for class II | |
| Maintenance immunosuppressive regimen | FK506/PRED/MMF | FK506/PRED/Myfortic acid | FK506/PRED/MMF | FK506/PRED/MMF |
| Time from transplant to diagnosis of recurrent disease | 3 | 4 | 5 | 3 |
| Baseline serum creatinine (mg/dl) | 1.9 | 1.2 | 1.4 | 0.9 |
| Parameters at the time of first biopsy showing recurrence | ||||
| serum creatinine (mg/dl) | 2.8 | 3.7 | 4.8 | 1.2 |
| 24-hour urine protein | 0.790 | 7.4 | 5.8 | 0.061 |
| serum albumin | 3.5 | 2.0 | 3 | 4.4 |
| edema | Yes | Yes | Yes | No |
| hematuria | Yes | Yes | Yes | No |
| serum complement | Normal C3 and C4 then low C3 and C4 3 months postbiopsy | Low C3 and C4 | Low C3 and C4 | Normal C3 and C4 |
| serum paraprotein | Negative (also normal serum free K:L) | Negative | Negative (also normal serum free K:L) | Negative |
| urine paraprotein | Negative | Negative | Negative | Not done |
| serum cryoglobulin | Negative | Negative | Negative | Not done |
| hepatitis C antibody | Negative | Negative | Negative | Not done |
| ANA | Negative | Negative | Negative | Not done |
| Treatment of recurrent disease | PRED and PO CYT for 6 months, after the third biopsy | M-PRED/PO PRED for 8 months/RIT ×2/lisinopril for 6 months | M-PRED/RIT ×1/PLX ×4/HD ×3 | M-PRED for ACR/RIT ×2 |
| Duration of posttransplant follow-up in months | 15 | 11 | 83 | 63 |
| Outcome | Final serum creatinine: 2.3 mg/dl | Final serum creatinine: 1.1 mg/dl | Final serum creatinine: 1.3 mg/dl | Final serum creatinine: 2.3 mg/dl |
| Final 24-hour urine protein: 0.128 g | Final 24-hour urine protein: 0.390 g | Final 24-hour urine protein: 0.629 g | Final 24-hour urine protein: 0.059 g |
PRA, panel reactive antibody; FK506, tacrolimus; HD, hemodialysis; K:L, kappa:lambda; M-PRED, methyl-prednisolone; PLX, plasmapheresis; RIT, rituximab.
a
Measured in pretransplant serum.