Apresenta

1
Desensibilização em transplante renal
experiência da PUCRS (relato de caso)
David Saitovitch
2012
2
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
3
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
IgA Nephropathy
4
Case presentation
G.C.V.J., 49-year-old, Brazilian, caucasian,
female
IgA Nephropathy
dialysis since 07/2000
5
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
IgA Nephropathy
dialysis since 07/2000
2 pregnancies, 10 blood transfusions, 1st kidney
tx 06/2003
6
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
IgA Nephropathy
dialysis since 07/2000
2 pregnancies, 10 blood transfusions, 1st kidney
tx 06/2003
Primary non-function....
7
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
IgA Nephropathy
dialysis since 07/2000
2 pregnancies, 10 blood transfusions, 1st kidney
tx 06/2003
Primary non-function.... Etiology????
8
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
9
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis Waiting list
10
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis Waiting list
CMs
11
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis Waiting list
CMs ?
12
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis Waiting list
CMs ?
PRA (CDC) ? gt90
13
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis Waiting list
vascular access...
14
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis Waiting list
vascular access... dificult!
15
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Peritoneal dialysis 03/2006
16
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Peritoneal dialysis 03/2006
Peritonitis
17
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Peritoneal dialysis 03/2006
ultrafiltration... failure!
18
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
19
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis 03/2008
20
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis 03/2008
vascular access... dificult!
21
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis 03/2008
vascular access... dificult!
Priority on the waiting list (2009)!
22
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
23
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
?CMs
24
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
?CMs ?
25
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
?CMs ?
2009
26
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
PRA (CDC) ? gt95
27
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
PRA (Flow) ? gt95
28
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30
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
Desensitization protocol
31
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
ivig
Desensitization protocol
32
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
ivig
2g/Kg (monthly) 2010
Desensitization protocol
33
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
ivig
CMs ?
2g/Kg (monthly) 2010
Desensitization protocol
34
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
ivig
CMs ?
2g/Kg (monthly) 2010
PRA...??
Desensitization protocol
35
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
PP/ivig
0.1g/Kg Jan 2011
Desensitization protocol
36
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Hemodialysis
Priority on the waiting list!
PP/ivig
Deceased donor allograft 21/02/11
0.1g/Kg Jan 2011
Desensitization protocol
37
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
38
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
A B DR
Recipient 2,24 35,65 13,16
Donor 2, - 51,57 13,17
39
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
A B DR
Recipient 2,24 35,65 13,16
Donor 2, - 51,57 13,17
40
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
A B DR
Recipient 2,24 35,65 13,16
Donor 2, - 51,57 13,17
41
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
DQ2
A B DR
Recipient 2,24 35,65 13,16
Donor 2, - 51,57 13,17
42
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Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
CDC Cross-match (-)
45
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
CDC Cross-match (-) Flow Cross-match ()
46
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11
CDC Cross-match (-) Flow Cross-match ()
47
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
Deceased donor allograft 21/Feb/11

• Cold ischemia 32 h
• Anastomosis time 40 min.

48
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female

• Immunosuppression
• Thymo (1,5mg/kg)
• Tac
• MMF
• Prednisone
• PP/ivig

Deceased donor allograft 21/Feb/11
49
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
(days)
50
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(mg/dL)
??
?Thymoglobuline
(days)
51
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
?Thymoglobuline
HD
(days)
52
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
?Thymoglobuline
HD
(days)
53
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
?Thymoglobuline
HD
(days)
54
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
55
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
56
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
57
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
58
11/03/11 MFI8694
11/03/11 MFI12093
DQ2
B57
14/02/11 MFI5034
28/02/11 MFI2465
14/02/11 MFI2434
28/02/11 MFI2549
59
11/03/11 MFI8694
11/03/11 MFI12093
DQ2
B57
14/02/11 MFI5034
28/02/11 MFI2465
14/02/11 MFI2434
28/02/11 MFI2549
60
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
61
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
62
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
63
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
64
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
65
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
66
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
67
11/03/11 MFI8694
11/03/11 MFI12093
DQ2
B57
14/02/11 MFI5034
28/02/11 MFI2465
14/02/11 MFI2434
28/02/11 MFI2549
68
11/03/11 MFI8694
11/03/11 MFI12093
DQ2
B57
14/02/11 MFI5034
28/02/11 MFI2465
14/02/11 MFI2434
28/02/11 MFI2549
69
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
? graft biopsy
(days)
70
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71
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72
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73
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74
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75
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76
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77
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78
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79
C4d
80
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
81
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
? Tac dose (blood levels 13 ng/ml)
(days)
82
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
? bortezomib 1st
(days)
83
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
84
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
85
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
? Tac dose (blood levels 16.3 ng/ml)
(days)
86
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
? bortezomib 2nd
(days)
87
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
88
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
89
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
? bortezomib 3rd
(days)
90
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
91
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
92
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
? bortezomib 4th
(days)
93
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
94
11/03/11 MFI12093
DQ2
B57
11/03/11 MFI8694
14/02/11 MFI5034
28/02/11 MFI2549
21/03/11 MFI5998
14/02/11 MFI2434
28/02/11 MFI2465
21/03/11 MFI4218
95
11/03/11 MFI12093
DQ2
B57
11/03/11 MFI8694
14/02/11 MFI5034
28/02/11 MFI2549
21/03/11 MFI5998
14/02/11 MFI2434
28/02/11 MFI2465
21/03/11 MFI4218
96
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
HD
HD
(days)
97
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
??
??
??
??
??
??
??
?Thymoglobuline
DISCHARGED
HD
HD
(days)
98
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
(mo)
99
DQ2
B57
11/03/11 MFI8694
11/03/11 MFI12093
14/02/11 MFI5034
20/04/11 MFI4640
21/03/11 MFI5998
21/03/11 MFI4218
31/03/11 MFI5532
14/02/11 MFI2434
28/02/11 MFI2465
20/04/11 MFI2141
31/03/11 MFI2188
28/02/11 MFI2549
100
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
(mo)
101
11/03/11 MFI8694
11/03/11 MFI12093
B57
DQ2
23/05/11 MFI6038
31/03/11 MFI5532
14/02/11 MFI5034
21/03/11 MFI4218
23/05/11 MFI3013
21/03/11 MFI5998
14/02/11 MFI2434
20/04/11 MFI2141
28/02/11 MFI2465
20/04/11 MFI4640
05/05/11 MFI3435
31/03/11 MFI2188
28/02/11 MFI2549
05/05/11 MFI1322
102
11/03/11 MFI8694
11/03/11 MFI12093
B57
DQ2
23/05/11 MFI6038
31/03/11 MFI5532
14/02/11 MFI5034
21/03/11 MFI4218
23/05/11 MFI3013
21/03/11 MFI5998
14/02/11 MFI2434
20/04/11 MFI2141
28/02/11 MFI2465
20/04/11 MFI4640
05/05/11 MFI3435
31/03/11 MFI2188
28/02/11 MFI2549
05/05/11 MFI1322
103
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
(mo)
104
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
APN
(mo)
105
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
APN - Cefepime
(mo)
106
11/03/11 MFI8694
11/03/11 MFI12093
DQ2
B57
23/05/11 MFI6038
21/03/11 MFI5998
14/02/11 MFI5034
20/04/11 MFI4640
21/03/11 MFI4218
31/03/11 MFI5532
14/02/11 MFI2434
20/04/11 MFI2141
04/08/11 MFI1457
23/05/11 MFI3013
28/02/11 MFI2465
05/05/11 MFI3435
04/08/11 MFI2045
28/02/11 MFI2549
31/03/11 MFI2188
05/05/11 MFI1322
107
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
(mo)
108
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109
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110
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
(mo)
111
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112
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113
Case presentation
G.C.V.J., 49-year-old Brazilian, Caucasian
female
(Tac MMF Pred)
(mg/dL)
Acknowledgements to Dr. Jorge M. Neumann et
al. Laboratorio de Imunologia de Transplantes
Hospital Don Vicente Scherer
(mo)