1. Desensibilização em transplante renal – experiência da PUCRS (relato de caso) HOSPITAL SÃO LUCAS DA PUCRS SERVIÇO DE NEFROLOGIA 2012 David Saitovitch

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

3. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation IgA Nephropathy

4. G.C.V.J., 49-year-old, Brazilian, caucasian, female Case presentation IgA Nephropathy dialysis since 07/2000

5. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation IgA Nephropathy 2 pregnancies, 10 blood transfusions, 1st kidney tx 06/2003 dialysis since 07/2000

6. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation IgA Nephropathy Primary non-function.... 2 pregnancies, 10 blood transfusions, 1st kidney tx 06/2003 dialysis since 07/2000

7. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation IgA Nephropathy Primary non-function.... Etiology???? 2 pregnancies, 10 blood transfusions, 1st kidney tx 06/2003 dialysis since 07/2000

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

9. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Waiting list

10. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Waiting list CMs

11. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Waiting list CMs → +

12. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Waiting list CMs → + PRA (CDC) → >90%

13. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Waiting list vascular access...

14. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Waiting list vascular access... dificult!

15. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Peritoneal dialysis 03/2006

16. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Peritoneal dialysis 03/2006 Peritonitis

17. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation ultrafiltration... failure! Peritoneal dialysis 03/2006

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

19. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis 03/2008

20. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation vascular access... dificult! Hemodialysis 03/2008

21. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation vascular access... dificult! Priority on the waiting list (2009) ! Hemodialysis 03/2008

22. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list!

23. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! ↑ CMs

24. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! ↑ CMs → +

25. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! ↑ CMs → + 2009

26. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! PRA (CDC) → >95%

27. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! PRA (Flow) → >95%

30. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! Desensitization protocol

31. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! Desensitization protocol ivig

32. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! Desensitization protocol ivig 2g/Kg (monthly) 2010

33. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! Desensitization protocol ivig 2g/Kg (monthly) 2010 CMs → +

34. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! Desensitization protocol ivig 2g/Kg (monthly) 2010 CMs → + PRA...??

35. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! Desensitization protocol PP/ivig 0.1g/Kg Jan 2011

36. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Hemodialysis Priority on the waiting list! Desensitization protocol PP/ivig 0.1g/Kg Jan 2011 Deceased donor allograft 21/02/11

37. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11

38. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11ABDRRecipient2,2435,6513,16 Donor 2, - 51,5713,17

39. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11ABDRRecipient2,2435,6513,16 Donor 2, - 51,5713,17

40. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11ABDRRecipient2,2435,6513,16 Donor 2, - 51,5713,17

41. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11ABDRRecipient2,2435,6513,16 Donor 2, - 51,5713,17 DQ2

44. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11 CDC Cross-match (-)

45. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11 CDC Cross-match (-) Flow Cross-match (+)

46. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11 CDC Cross-match (-) Flow Cross-match (+)

47. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11 Cold ischemia – 32 h Anastomosis time – 40 min.

48. G.C.V.J., 49-year-old Brazilian, Caucasian female Case presentation Deceased donor allograft 21/Feb/11 Immunosuppression Thymo (1,5mg/kg) Tac MMF Prednisone PP/ivig

49. (mg/dL) (days) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred)

50. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female

51. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD (Tac + MMF + Pred)

52. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week (Tac + MMF + Pred)

53. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female  HD (Tac + MMF + Pred) PP/IVIG 3x/week

54. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week (Tac + MMF + Pred)

55. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

56. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

57. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

58. B*57 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 DQ*2

59. B*57 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 DQ*2

60. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

61. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

62. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

63. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

64. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

65. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

66. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

67. B*57 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 DQ*2

68. B*57 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 DQ*2

69. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)  graft biopsy

79. C4d+

80. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

81. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)  Tac dose (blood levels 13 ng/ml)

82. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)  bortezomib 1st

83. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

84. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

85. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)  Tac dose (blood levels 16.3 ng/ml)

86. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)  bortezomib 2nd

87. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

88. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

89. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)  bortezomib 3rd

90. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

91. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

92. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)  bortezomib 4th

93. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

94. B*57 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 DQ*2 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 21/03/11 MFI=5998 21/03/11 MFI=4218

95. B*57 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 DQ*2 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 21/03/11 MFI=5998 21/03/11 MFI=4218

96. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred)

97. (mg/dL) (days)  Thymoglobuline Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female HD PP/IVIG 3x/week PP/IVIG 3x/week (Tac + MMF + Pred) DISCHARGED

98. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred)

99. B*57 DQ*2 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 21/03/11 MFI=5998 31/03/11 MFI=5532 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 21/03/11 MFI=4218 31/03/11 MFI=2188 20/04/11 MFI=4640 20/04/11 MFI=2141

100. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred)

101. 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 21/03/11 MFI=5998 31/03/11 MFI=5532 20/04/11 MFI=4640 05/05/11 MFI=3435 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 21/03/11 MFI=4218 31/03/11 MFI=2188 20/04/11 MFI=2141 05/05/11 MFI=1322 23/05/11 MFI=3013 23/05/11 MFI=6038 B*57DQ*2

102. 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 21/03/11 MFI=5998 31/03/11 MFI=5532 20/04/11 MFI=4640 05/05/11 MFI=3435 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 21/03/11 MFI=4218 31/03/11 MFI=2188 20/04/11 MFI=2141 05/05/11 MFI=1322 23/05/11 MFI=3013 23/05/11 MFI=6038 B*57DQ*2

103. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred)

104. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred) APN

105. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred) APN - Cefepime

106. 14/02/11 MFI=5034 28/02/11 MFI=2465 11/03/11 MFI=8694 21/03/11 MFI=5998 31/03/11 MFI=5532 20/04/11 MFI=4640 05/05/11 MFI=3435 23/05/11 MFI=6038 04/08/11 MFI=2045 14/02/11 MFI=2434 28/02/11 MFI=2549 11/03/11 MFI=12093 21/03/11 MFI=4218 31/03/11 MFI=2188 20/04/11 MFI=2141 05/05/11 MFI=1322 23/05/11 MFI=3013 04/08/11 MFI=1457 DQ*2B*57

107. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred)

110. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred)

113. (mg/dL) (mo) Case presentation G.C.V.J., 49-year-old Brazilian, Caucasian female (Tac + MMF + Pred) Acknowledgements to Dr. Jorge M. Neumann et al. Laboratorio de Imunologia de Transplantes – Hospital Don Vicente Scherer