A 35-yr-old Caucasian male with type 1 diabetes and chronic kidney disease received a one-haplotype matched living-donor transplant from his sister in June 2004. No pre-transplantation sensitization was noted. The early post-transplantation course was unremarkable, and the baseline serum creatinine level was 1.6 mg/dL. Medications Tacrolimus (maintaining trough levels of approximately 10 mg/dL) Mycophenolate mofetil (MMF) 2000 mg/d Prednisone 10 mg/d at 3 months after transplantation and 5 mg/d by 6 months after transplantation.
At 6 months after transplantation, MMF was held by the patient for 3 to 4 days because of an episode of diarrhea and then restarted at a dose of 1500 mg/d. At 12 months after transplantation, his creatinine level increased asymptomatically to 2.4 mg/dL. The patient adhered to his immunosuppressive regimen. A presumptive diagnosis of acute rejection was made and…
