{"id":11347,"date":"2026-10-14T04:59:25","date_gmt":"2026-10-14T04:59:25","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=11347"},"modified":"2026-10-14T05:13:51","modified_gmt":"2026-10-14T05:13:51","slug":"late-renal-allograft-dysfunction","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-october-2026\/late-renal-allograft-dysfunction\/","title":{"rendered":"Late Renal Allograft Dysfunction"},"content":{"rendered":"

[vc_section][vc_row][vc_column][vc_column_text]<\/p>\n

Mixed Antibody-Mediated and Chronic Active T-Cell-Mediated Rejection \u2022 Case Summary<\/h3>\n\n\n\n\n\n\n\n\n
Clinical<\/strong><\/td>\n30-year-old female; living-related renal transplant20\/08\/2017; -9 years post-transplant; worsening grak function.<\/td>\n<\/tr>\n
Laboratory<\/strong><\/td>\nCreatinine 3.96 mg\/dL; BUN 83.8 mg\/dL; urine protein 1+; blood 1+; albumin 2.8 g\/dL; Hb 10g\/dL.<\/td>\n<\/tr>\n
Biopsy<\/strong><\/td>\n7\/7 glomeruli globally sclerosed; 25-50% IFTA; dense interstitial inflammation; significant tubulitis; prominent peritubular capillaritis.<\/td>\n<\/tr>\n
C4d<\/strong><\/td>\n3+ with linear staining in >50% peritubular capillaries. Supports complement activation and an antibody-associated process.<\/td>\n<\/tr>\n
Interpretation<\/strong><\/td>\nAntibody-mediated component plus chronic active T-cell-mediated rejection, Banff grade I\u0412, with substantial chronic allograft injury.<\/td>\n<\/tr>\n
Treatment<\/strong><\/td>\nIV methylprednisolone 500 mg OD for 3 days, followed by oral prednisolone. Creatinine improved to 1.5 mg\/dL.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

What must be correlated<\/h2>\n

DSA, tacrolimus\/cyclosporine lsvsJs, immunosuppression adherence, BK-virus PCR, prior biopsy<\/strong> findings and the renal
\nfunction trajectory. C4d alone should not be treated as sufficient for definitive ABMR classification.<\/p>\n

Prognostic point<\/h2>\n

The creatinine response suggestsa steroid-responsive active inflammatory component. However, 25-50% IFTA and global
\nsclerosis of all 7 sampled glomeruli represent established chronic injury<\/strong>, some of which is irreversible.<\/p>\n

Presentation closing line<\/h2>\n

“This case demonstrates that late renal allograft dysfunction may reflect simultaneous active immune-mediated injury and
\nadvanced chronic scarring; accurate classification requires integration of biopsy findings with C4d and DSA.”<\/p>\n

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LATE RENAL ALLOGRAFT DYSFUNCTION<\/h2>\n

Mixed antibody-mediated + chronic active T-cell-mediated rejection<\/strong><\/p>\n

30-year-old female Living-related transplant 20 Aug 2017~9 years post-transplant<\/p>\n

Presenting with azotemia \/ worsening graft function<\/p>\n

Clinical & Lab Snapshot<\/h3>\n