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Am J Transplant ; 22(1): 289-293, 2022 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1345918

RESUMEN

Neutralizing monoclonal antibodies such as bamlanivimab emerged as promising agents in treating kidney transplant recipients with COVID-19. However, the impact of bamlanivimab on kidney allograft histology remains unknown. We report a case of a kidney transplant recipient who received bamlanivimab for COVID-19 with subsequent histologic findings of diffuse peritubular capillary C4d staining. A 33-year-old man with end-stage kidney disease secondary to hypertension who received an ABO compatible kidney from a living donor, presented for his 4-month protocol visit. He was diagnosed with COVID-19 44 days prior to his visit and had received bamlanivimab with an uneventful recovery. His 4-month surveillance biopsy showed diffuse C4d staining of the peritubular capillaries without other features of antibody-mediated rejection (ABMR). Donor-specific antibodies were negative on repeat evaluations. ABMR gene expression panel was negative. His creatinine was stable at 1.3 mg/dl, without albuminuria. Given the temporal relationship between bamlanivimab and our observations of diffuse C4d staining of the peritubular capillaries, we hypothesize that bamlanivimab might bind to angiotensin-converting enzyme 2, resulting in classical complement pathway and C4d deposition. We elected to closely monitor kidney function which has been stable at 6 months after the biopsy. In conclusion, diffuse C4d may present following bamlanivimab administration without any evidence of ABMR.


Asunto(s)
COVID-19 , Trasplante de Riñón , Adulto , Aloinjertos , Anticuerpos Monoclonales Humanizados , Anticuerpos Neutralizantes , Biopsia , Capilares , Complemento C4b , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/etiología , Humanos , Riñón , Trasplante de Riñón/efectos adversos , Masculino , Fragmentos de Péptidos , SARS-CoV-2 , Coloración y Etiquetado
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