Fig. 1.

Course of disease: diagram showing laboratory values (serum creatinine, platelets, haemoglobin, haptoglobin) and immunosuppressive therapy over 18 months. Initiation of belatacept is indicated by vertical blue line (‘1’) and was given as follows: 750 mg belatacept weekly for 3 weeks, followed by a 4-weekly administration. (‘2’) Initiation of eculizumab is indicated by vertical dark green line and was administered as follows: 900 mg eculizumab weekly for 4 weeks, followed by 1200 mg eculizumab maintenance 2-weekly (‘3’). (‘4’) Discontinuation of eculizumab therapy after 19 weeks post-RTX resulted in rising serum creatinine and recurring haemolytic anaemia; however, re-initiation of eculizumab therapy (‘5’) led to prompt response and subsequent haematological remission. Horizontal lines denote upper (creatinine)/lower range (platelets, haemoglobin, haptoglobin) of respective reference levels.