PMC4958444_01
Kidney biopsy findings: (a) transplant glomerulitis with infiltrating mononuclear inflammatory cells within the capillary loops, second biopsy (PAS, magnification x200); (b) glomerulus with a thrombus involving the vascular pole, second biopsy (Jones, magnification x200); (c) glomeruli showing persistent transplant glomerulitis and thrombotic microangiopathy, fourth biopsy (PAS, magnification x100); (d) immunofluorescence microscopy showing C4d mesangial deposition without peritubular capillary staining (magnification x100).
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IA cellular rejection (Figure 1). Immunohistochemistry for CMV was negative. We decided to treat the recipient with 3 doses of eculizumab (1200 mg, 900 mg, and 900 mg) (Figure 1). The last graft biopsy (8 months after transplant) showed ongoing AMR and progression of chronic lesions (moderate tubular atrophy and interstitial fibrosis) (Figure 1).
Graft function and microangiopathy markers.
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Following the therapy, blood markers of TMA significantly improved (Figure 2).