Abstract: TH-PO1038
Beyond Nonadherence: Systems-Level Barriers in Kidney Allograft Failure
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Desai, Parth, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
- Liu, Shiguang, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
- Hicks, Sydney, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
- Hasan, Irtiza, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
Introduction
Long-term kidney transplant survival depends on healthcare access, medication adherence, & continued multidisciplinary follow-up. Years after transplantation, patients remain vulnerable to fragmented care & medication interruption. We present a case of acute cellular rejection resulting in dialysis-dependent graft failure in the setting of disrupted long-term transplant support.
Case Description
A 39-year-old female with ESRD status post deceased donor kidney transplant 6 years ago, HTN, & insulin-dependent type 2 DM, presented with progressive allograft dysfunction after interruption of maintenance immunosuppressive (IS) therapy. Baseline creatinine was 1.2–1.4 mg/dL. She had multiple prior admissions related to medication nonadherence associated with inconsistent transplant follow-up & loss of insurance coverage. Laboratory evaluation demonstrated severe AKI with creatinine rising to 5.9 mg/dL,azotemia, metabolic acidosis, hyperkalemia, & volume overload. Renal allograft biopsy demonstrated acute cellular rejection (Banff grade 1B) with diffuse interstitial inflammation (>50% cortex, i3), severe focal tubulitis,& ATN with mild chronic changes. No evidence of antibody-mediated rejection was identified. The patient received pulse intravenous corticosteroids followed by Thymoglobulin due to worsening graft dysfunction. Hospitalization was complicated by pulmonary edema, hypoxemia, dialysis-requiring volume overload & transient interruption of Thymoglobulin therapy due to patient refusal. Despite aggressive rescue therapy, the patient remained dialysis dependent.
Discussion
This is one of many cases highlighting how systems-level barriers can critically impact long-term transplant outcomes despite initially stable graft function. Interruption of IS therapy occurred in the setting of inconsistent follow-up, loss of insurance coverage, & reduced social support, ultimately resulting in severe acute cellular rejection & dialysis-dependent graft failure. Our case illustrates challenges faced by younger transplant recipients years after transplantation, including transition to independent healthcare management, treatment fatigue, and family planning concerns while on IS medications. Ongoing transplant education & multidisciplinary support addressing medication access, adherence, and early recognition of graft dysfunctionremain essential to prevent irreversible allograft injury or loss.