Case Scenario: Post transplant monitoring and rejection
Case Study: 20 year old son of a business mogul has presented with increasing creatinine at 6 months post transplant. On history, he notes he has now gotten busy with working at the family business and with partying with his friends and may have missed a few meds at night. You admit him for a kidney biopsy. Previous immunological workup is below.
| Sensitization History | None | |||||
| HLA Typing | A | B | C | DR | DQ | DP |
| Donor (B+) | 02:03, 24:02 | 38:02, 49:01 | 07:01, 07:02 | 13:01, 15:02 | 05:01, 06:03 | 02:01, 04:01 |
| Recipient (B+) | 02:01, 02:03 | 13:01, 15:02 | 04:03, 08:01 | 12:02, 12:02 | 03:01, 03:01 | 13:01, 13:01 |
| XM | T cells | B Cells | ||||
| CDC XM | Negative | Negative | ||||
| Flow XM | Negative | Negative | ||||
| Single Antigen Bead | None | None | ||||
Questions & Answers
Q1. In addition to a kidney biopsy, what additional tests would you send?
Ans: Either post biopsy or with it: Single antigen bead.
Q2. After treatment of his rejection, How frequently should KFT and urine testing be performed?
Ans: At least monthly.
Q3. How frequently should tac level be tested and tac dose adjusted?
Ans: As above.
Q4. Should we perform additional testing, BK virus, SAB, Cell free DNA and if so, how frequently and how do we utilize the results to guide treatment?
Ans: As above but maybe more frequently post his rejection and at any time of dose changes or target changes.
