PMC8087480_01
Graft biopsy: (a) microthrombosis in peritubular capillary. (b) Interstitial arteriole with a thrombus and endothelial edema. (c) Thrombosis in glomerular capillaries with retraction of glomerulus and pseudoincrease of urinary space. (d) Peritubular capillaritis due polymorphonuclear leukocytes. (H&E and magnification x40). (e) C4d negative in peritubular capillaries (40x).
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fig1
Histological findings were thrombotic microangiopathy (TMA), C4D negative, and inflammatory infiltration of polymorphonuclear leukocytes inside peritubular capillaritis; humoral acute rejection was suspected based on these findings (Figure 1).
Evolution of graft function (SrCr) during antirejection treatment. Yellow arrows show plasmapheresis (days 8, 10, 12, 15, 17, and 19); green, rituximab (day 14); and purple, IG-IV treatment (days 9, 11, 13, 16, 18, and 20).
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fig2
The treatment choices are plasmapheresis (6 doses), intravenous immunoglobulin (6 doses 0.2 mg/kg), and in the middle (between 3 and 4 dose), rituximab 375 mg/m2 (Figure 2).