PMC5851299_01
Renal function and proteinuria over time. Renal function remained largely stable over 15 years, with intermittent decreases in renal function that led to transplant biopsies.
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Renal function was largely stable over a course of 15 years, with intermittent deterioration in function (Figure 1) which led to several biopsies.
Histologic assessment of renal transplant biopsy. The biopsy showed signs of chronic-active antibody-mediated rejection with severe tubular damage, interstitial edema, and peritubular capillaritis ((a) arrowheads); glomerulitis with double contours ((b) arrowheads); diffuse positive C4d staining in peritubular capillaries (c); and interstitial fibrosis with severe arteriosclerosis (d). ((a) H&E, (b) and (d) Jones methenamine, and (c) C4d immunohistochemistry; original magnification: (a) and (b) x60, (c) x20, and (d) x40).
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C4d staining, glomerular double contours, and severe atrophy/fibrosis) (Figure 2). Circulating HLA antibodies were detected (PRA I 24%, PRA II 30%), which were donor specific (HLA-A*24  (MFI  16422); HLA-DQ*05  (MFI  21521)).