Fig. 4

Clinical course after kidney transplantation. Immunosuppression was induced with tacrolimus (Tac), mycophenolate mofetil (MMF), methylprednisolone (mPSL), and basiliximab (BCM). Rituximab (Rit), two sessions of double filtration plasmapheresis (DFPP), and one session of plasma exchange were also induced as desensitization therapy because of ABO incompatibility and donor-specific antibodies positivity. The renal biopsy at 3 months revealed chronic active antibody-mediated rejection, and the patient was treated with pulse mPSL, Rit, and two sessions of DFPP. The urinary protein remained positive; however, the patient preserved renal graft function throughout the follow-up period. Abbreviations: Cre, creatinine; KTx, kidney transplantation; M, months; PE, plasma exchange; UPCR, urinary protein-to-creatinine ratio