Wcn26-8023 Barriers to Living Donor Renal Transplantation: Experience From a Centrally Located Dialysis Unit in Northern Pakistan

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.