PMC5763091_01
Kidney function (a), isoagglutinin titers (b), and hematological parameters (c) in patient 1. Evolution after kidney transplantation.
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fig1
At that time, serum creatinine level was 546 mumol/L (Figure 1).
PMC5763091_02
Kidney function (a), isoagglutinin titers (b), and hematological parameters (c) in patient 2. Evolution after transplantation.
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fig2
At POD 1, the patient presented with biological features of TMA, including hemolytic anemia, thrombocytopenia (platelet count at 49,000/mm3), and no improvement in kidney function (Figure 2). Rapidly after initiation of eculizumab, hematological parameters improved, as well as kidney function (Figure 2).
(a) Kidney allograft biopsy at postoperative day 12 in patient 2: thrombotic microangiopathy lesions, antibody-mediated rejection (t0, i0, g3, and cpt2). (b) Kidney allograft biopsy at postoperative day 54 in patient 2. Lesions of mixed acute cellular and antibody-mediates rejection (i2 i2 ti2 g2 cpt2), IF/TA 1, and no more lesions of thrombotic microangiopathy.
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fig3
A first kidney biopsy was done on POD 12 (Figure 3(a)) and revealed thrombotic microangiopathy, glomerulitis (g3), peritubular capillaritis (cpt2), and a peritubular C4d deposition. TMA lesions (Figure 3(b)). Three methylprednisolone pulses were given and immunoabsorption sessions were restarted (2 session/week for 6 weeks).