Abstract

SILVA, Rui F. et al. The gray area between operational tolerance and overt rejection in kidney transplantation. Port J Nephrol Hypert [online]. 2021, vol.35, n.4, pp.260-262.  Epub Dec 30, 2021. ISSN 0872-0169.  https://doi.org/10.32932/pjnh.2021.12.162.

Operational tolerance in kidney transplantation is characterized by stable serum creatinine < 1.7 mg/dL and proteinuria < 1 g/day in the absence of immunosuppression or immunodeficiency for over one year. However, simultaneous donor specific antibodies are common and serum creatinine is a poor surrogate of early lesions. Consequently, subclinical rejections will meet operational tolerance criteria if sérum creatinine remains stable. We report a patient with operational tolerance criteria followed by biopsy-proven chronic active antibody mediated rejection, discussing the intricate challenges of immunosuppression management.

Keywords : kidney transplantation; operational tolerance; antibody mediated rejection.

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