(Donor was father and CDC crossmatch as well as DSA by luminex are negative.)
This patient was dignosed as aHUS in July 2012 after P.vivax malaria infection treated with Quinine. HUS was not responded to plasmapharesis and steroid (managed by another nephrologist). He progressed to ESRD and started hemodialysis 3 times a week. Kidney transplant was done in August, 2013 after confirming that there is no ongoing hemolysis. Baseline immunosuppresants were tacrolimus, MMF and steroid with ATG as induction agent. Baseline S.Creat was 1.2 . Within 3 months patient was switched to everolimus from Tac. S.Creat was steady at 1.1 for 9 months and then increased to 1.8. Kidney biopsy was showing features of acute ABMR with c4d positivity and fibrinoid necrosis in one glomeruli. Everolimus was switched to Tac. But, after 3 days, markers of haemolysis became positive that were earlier normal. So Tac was switched to everolimus. After giving 3 pulse doses of methylpred, we have started plasmapharesis with rituximab. S.creat after 2 cycles of plasmapharesis is 1.6.