mycophenolate mofetil, and tacrolimus, as well as plasma exchange and IVIG.A kidney transplant was performed on November 22. On postoperative day 2, Cre improved to 1.3 mg/dL, but gradually increased from postoperative day 5 and did not respond to additional plasma exchange and steroid therapy.Proteinuria remained unchanged before and after surgery, at approximately 15 g/day.Hemodialysis was required from postoperative day 21, and a transplant kidney biopsy was performed on postoperative day 32.The biopsy showed tubulointerstitial inflammation and negative C4d deposition with intraluminal proliferation, leading to a diagnosis of FSGS recurrence.Results: Dara was administered on postoperative days 34 and 53, but it was unsuccessful and renal function was lost.Conclusion: Although immunosuppressive agents are expected to be effective in anti-nephrin antibody-positive FSGS, relapse after transplantation can occur even following B-cell depletion therapy with RTX, suggesting the possibility of antibody production by plasma cells.In this case, Dara, an anti-CD38 monoclonal antibody, was administered with the expectation that it would suppress plasma cell-derived antibody production, but it was ineffective.This may be due to the already lost renal function or the possibility of antibody leakage via lowselectivity proteinuria.Japan Renal Transplantation Physician Association I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Rashid et al. (Wed,) studied this question.