A 39-year-old male who received living kidney from his 62-year-old father, blood group matched and CDC cross match all negative, having acute cell mediated rejection 5 hours after transplant due to low Tacrolimus Trough level: A case report

Abstract

A young renal transplant recipient received living kidney from his father; the Centers for Disease Control and Prevention (CDC) cross match was all negative. He had oliguria 5 hours after transplant with fever and neutrophil leukocytosis. Doppler ultrasonogram revealed increased cortical echo with increased Resistive Index suggesting acute rejection or acute tubular necrosis. Renal transplant biopsy revealed acute T cell mediated rejection (acute TCMR) Grade IIA. Trough level of Tacrolimus blood level done on Day 5 was very low; therefore, Tacrolimus dose was increased. Therapeutic level achieved after giving 6 mg twice a day with addition of erythromycin. Escalating antibiotics, increasing steroids and Tacrolimus dose saved the transplant kidney.