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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
