Challenging Case - Diagnosis of Acute Rejection in Kidney Transplantation: A Clinical Update

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* 1. DJT is 75 years old, 2 years post living donor kidney transplant (LDKTx) for FSGS/CKD due to obesity and hypertension. Serum creatinine has risen slowly over the last 6 months from 1.5 mg/dL to 1.9 mg/dL. Urine protein is mildly elevated. Tacrolimus trough levels have been inconsistently both high and low. A donor-derived cell-free DNA (dd-cfDNA) assay is obtained and is 1.3%.
What would you want to do next?

A. Donor-specific antibody assay

B. Kidney Biopsy

C. Diagnostic ultrasound

D. Percutaneous nephrostomy

E. A and C

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* 2. What is your level of confidence that your choice is correct?

High

Medium

Low

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* 3. A 52 year-old male received a kidney transplant 2 months ago. His immunosuppression therapies include tacrolimus and mycophenolate mofetil. His overall health has been stable since the transplant and reportedly he has been adherent with his medications.

Which of the following statements are true about this patient?

A. Acute rejection is no longer a concern for this patient

B. Delayed graft function can still occur with this patient

C. Acute rejection can still occur with this patient

D. Acute CNI nephrotoxicity is no longer a concern for this patient

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* 4. What is your level of confidence that your choice is correct?

High

Medium

Low