Severe Rejection of an HL-A Identical Sibling Renal Transplant

A twenty-year-old patient with end-stage pyelonephritis received an HL-A identical renal transplant from her brother. She remained well for 28 days and then suffered a severe rejection episode while on decreased immunosuppressive therapy because of low white blood counts, reducing renal function to a creatinine clearance of 32 ml/min. Two weeks later she suffered a second major rejection episode which was arrested at a clearance of 10 ml/min. For the last 10 months renal function has remained stable at this level.