Abstract: FR-PO0799
Rejection and Recurrence: Analyzing Complications of a Two-Time Deceased Donor Kidney Transplant Pediatric Recipient
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Kuo, Ashley, CORE Kidney Program, UCLA Health, Los Angeles, California, United States
- Wong, Rain H., CORE Kidney Program, UCLA Health, Los Angeles, California, United States
- Schneider, Evan, CORE Kidney Program, UCLA Health, Los Angeles, California, United States
- Bhargava, Sohum, CORE Kidney Program, UCLA Health, Los Angeles, California, United States
- Oest, Dylan, CORE Kidney Program, UCLA Health, Los Angeles, California, United States
- Rodriguez-Martinez, Nayeli, CORE Kidney Program, UCLA Health, Los Angeles, California, United States
- Rastogi, Anjay, CORE Kidney Program, UCLA Health, Los Angeles, California, United States
Introduction
Membranoproliferative glomerulonephritis (MPGN) is a rare disease characterized by proliferation of mesangial cells and thickening of the peripheral walls. Type II, also commonly known as dense deposit disease (DDD), is significant due to its association with recurrence after renal transplants. This case highlights a rare presentation of graft dysfunction and eventual graft failure in a patient with underlying MPGN II within the context of Epstein-Barr virus (EBV).
Case Description
An 18-year-old female with a history of MPGN II and low grade EBV viremia presents with mildly elevated creatinine (Cr) and worsening proteinuria, undergoing a transplant kidney biopsy. She was on hemodialysis (HD) starting at 8-years-old, eventually receiving a deceased donor kidney transplant (DDKT) at 11-years-old. 6 years later, a biopsy on the transplanted kidney revealed findings consistent with Ab-mediated rejection, and the patient was prescribed solumedrol, IVIG, and a one-time dose of rituximab. A follow up biopsy 4 months later showed no rejection. Post-biopsy the next year, the patient’s pathology results showed DDD consistent with recurrence of MPGN. 2 months later, she was readmitted for hypertension (HTN), edema, and initiation of eculizumab therapy.
At age 22, the patient was admitted for HTN and peripheral edema. Following treatment of Albumin with lasix IV, she experienced fluid overload and was immediately diuresed. Urinalysis results showed 3+ proteinuria, 1+ hematuria with hyaline and granular casts, asymptomatic bacteriuria, and BUN/Cr > 20. Upward trending Cr and reliance on Lasix indicated significant need for dialysis. The patient’s graft was officially declared lost, and she was placed on HD until receiving a second DDKT 4 years later. She immediately started eculizumab therapy to prevent MPGN II recurrence.
Discussion
This case highlights kidney transplant complications that may arise many years post-transplant. The patient’s graft loss was likely due to a multifactorial process exacerbated by antibody rejection and EBV viremia. Ultimately, the recurrence of MPGN II acted as the irreversible driver of graft failure. Upon receiving the second kidney transplant, the patient was started on Eculizumab to prevent early complement activation and mitigate the risk of disease recurrence in the allograft, suggesting that preventative management is important in DDD management.