Desensibilização em transplante Desensibilização em transplante renal – experiência da PUCRSrenal – experiência da PUCRS

(relato de caso)(relato de caso)

HOSPITAL SÃO LUCAS DA PUCRS

SERVIÇO DE NEFROLOGIA

2012

David Saitovitch

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

IgA Nephropathy

G.C.V.J., 49-year-old, Brazilian, caucasian, female

Case presentation

IgA Nephropathy

dialysis since 07/2000

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

IgA Nephropathy

2 pregnancies, 10 blood transfusions, 1st kidney tx 06/2003

dialysis since 07/2000

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

IgA Nephropathy

Primary non-function....

2 pregnancies, 10 blood transfusions, 1st kidney tx 06/2003

dialysis since 07/2000

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

IgA Nephropathy

Primary non-function.... Etiology????

2 pregnancies, 10 blood transfusions, 1st kidney tx 06/2003

dialysis since 07/2000

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

HemodialysisWaiting list

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

HemodialysisWaiting list

CMs

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

HemodialysisWaiting list

CMs → +

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

HemodialysisWaiting list

CMs → +

PRA (CDC) → >90%

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

HemodialysisWaiting list

vascular access...

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

HemodialysisWaiting list

vascular access...dificult!

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Peritoneal dialysis 03/2006

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Peritoneal dialysis 03/2006

Peritonitis

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

ultrafiltration...failure!

Peritoneal dialysis 03/2006

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis 03/2008

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

vascular access...dificult!

Hemodialysis 03/2008

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

vascular access...dificult!

Priority on the waiting list (2009)!

Hemodialysis 03/2008

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

↑CMs

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

↑CMs → +

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

↑CMs → +

2009

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

PRA (CDC) → >95%

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

PRA (Flow) → >95%

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

Desensitization protocol

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

Desensitization protocol

ivig

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

Desensitization protocol

ivig2g/Kg (monthly)

2010

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

Desensitization protocol

ivig2g/Kg (monthly)

2010

CMs → +

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

Desensitization protocol

ivig2g/Kg (monthly)

2010

CMs → +

PRA...??

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

Desensitization protocol

PP/ivig0.1g/Kg

Jan 2011

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Hemodialysis

Priority on the waiting list!

Desensitization protocol

PP/ivig0.1g/Kg

Jan 2011

Deceased donor

allograft 21/02/11

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

AA BB DRDR

RecipientRecipient 2,242,24 35,6535,65 13,1613,16

DonorDonor 2, -2, - 51,5751,57 13,1713,17

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

AA BB DRDR

RecipientRecipient 2,242,24 35,6535,65 13,1613,16

DonorDonor 2, -2, - 51,5751,57 13,1713,17

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

AA BB DRDR

RecipientRecipient 2,242,24 35,6535,65 13,1613,16

DonorDonor 2, -2, - 51,5751,57 13,1713,17

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

AA BB DRDR

RecipientRecipient 2,242,24 35,6535,65 13,1613,16

DonorDonor 2, -2, - 51,5751,57 13,1713,17

DQ2

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

CDC Cross-match (-)

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

CDC Cross-match (-)

Flow Cross-match (+)

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

CDC Cross-match (-)

Flow Cross-match (+)

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

Cold ischemia – 32 h

Anastomosis time – 40 min.

G.C.V.J., 49-year-old Brazilian, Caucasian female

Case presentation

Deceased donor

allograft 21/Feb/11

ImmunosuppressionThymo (1,5mg/kg) Tac MMF Prednisone PP/ivig

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD

(Tac + MMF + Pred)

PP/IVIG3x/week

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

B*5714/02/11MFI=5034 28/02/11

MFI=2465

11/03/11MFI=8694

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093DQ*2

B*5714/02/11MFI=5034 28/02/11

MFI=2465

11/03/11MFI=8694

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093DQ*2

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

B*5714/02/11MFI=5034 28/02/11

MFI=2465

11/03/11MFI=8694

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093DQ*2

B*5714/02/11MFI=5034 28/02/11

MFI=2465

11/03/11MFI=8694

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093DQ*2

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

graft biopsy

C4d+

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

Tac dose (blood levels 13 ng/ml)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

bortezomib 1st

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

Tac dose (blood levels 16.3 ng/ml)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

bortezomib 2nd

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

bortezomib 3rd

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

bortezomib 4th

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

B*5714/02/11MFI=5034

28/02/11MFI=2465

11/03/11MFI=8694

DQ*2

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093

21/03/11MFI=5998

21/03/11MFI=4218

B*5714/02/11MFI=5034

28/02/11MFI=2465

11/03/11MFI=8694

DQ*2

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093

21/03/11MFI=5998

21/03/11MFI=4218

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728

sCr

(mg/dL)

(days)

Thymoglobuline

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female

HD HD

PP/IVIG3x/week

PP/IVIG3x/week

(Tac + MMF + Pred)

DISCHARGED

DISCHARGED

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

B*57 DQ*2

14/02/11MFI=5034

28/02/11MFI=2465

11/03/11MFI=8694

21/03/11MFI=5998 31/03/11

MFI=553214/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093

21/03/11MFI=4218

31/03/11MFI=2188

20/04/11MFI=4640

20/04/11MFI=2141

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

14/02/11MFI=5034

28/02/11MFI=2465

11/03/11MFI=8694

21/03/11MFI=5998

31/03/11MFI=5532

20/04/11MFI=4640

05/05/11MFI=3435

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093

21/03/11MFI=4218

31/03/11MFI=2188

20/04/11MFI=2141

05/05/11MFI=1322

23/05/11MFI=3013

23/05/11MFI=6038

B*57 DQ*2

14/02/11MFI=5034

28/02/11MFI=2465

11/03/11MFI=8694

21/03/11MFI=5998

31/03/11MFI=5532

20/04/11MFI=4640

05/05/11MFI=3435

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093

21/03/11MFI=4218

31/03/11MFI=2188

20/04/11MFI=2141

05/05/11MFI=1322

23/05/11MFI=3013

23/05/11MFI=6038

B*57 DQ*2

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

APN

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

APN - Cefepime

14/02/11MFI=5034

28/02/11MFI=2465

11/03/11MFI=8694

21/03/11MFI=5998

31/03/11MFI=5532

20/04/11MFI=4640

05/05/11MFI=3435

23/05/11MFI=6038

04/08/11MFI=2045

14/02/11MFI=2434

28/02/11MFI=2549

11/03/11MFI=12093

21/03/11MFI=4218

31/03/11MFI=2188

20/04/11MFI=2141

05/05/11MFI=1322

23/05/11MFI=3013

04/08/11MFI=1457

DQ*2B*57

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12

sCr

(mg/dL)

(mo)

Case presentation

G.C.V.J., 49-year-old Brazilian, Caucasian female(Tac + MMF + Pred)

Acknowledgements to Acknowledgements to Dr. Jorge M. Neumann et al.Laboratorio de Imunologia de Transplantes – Hospital Don Vicente Scherer