Female patient, 37 years old, black, history of sickle cell anemia and end-stage chronic renal failure on hemodialysis for 6 years.
She had previously presented several episodes of sickle cell crises requiring multiple transfusions.
In November 2010, he underwent kidney transplantation from a deceased donor, sharing a RD and an A, with a cold ischemia time of 15 hours.
Induction was performed with alemtuzumab and methylprednisolone boluses.
During the transoperative period, the patient was hypotensive, requiring dopamine.
Renal graft perfusion was slow, with recovery during surgery.
In the postoperative period, the patient became anuric, with elevated levels of nitrogen and metabolic acidosis; peripheral blood increased 179, leucocytes reported hypochromia, 90, elevated hemoglobin %, 577, low density lipoprotein, 179.
Graft Doppler reported good vascular perfusion, but high resistance rates.
She suffered vaso-occlusive crisis of the graft and was managed with hydroxyurea and hemodialysis.
Biopsy of the renal graft was performed on the fifth day. The most important findings observed were areas of infarction in peritubular capillaries with the presence of neutrophils and erythrocyte peritubulary activitie in some cases positive.
With these findings, a diagnosis of acute humoral rejection and sickle cell crisis of the graft was made; treatment with pulses of methylprednisolone, plasmapheresis, tacrolimus, mycophenolate and exchange sickle cell crisis was performed.
Ten days after transplantation renal function improved and renal replacement therapy was suspended.
The last control creatinine, four months later, was 1.3 mg/dl.
