P029 A case of acute tubular necrosis, antibody mediated rejection, or both

We investigated the cause of impaired allograft function in the case of biopsy-proven Acute Tubular Necrosis (ATN) with C4d deposits, in the absence of other Antibody Mediated Rejection (AMR) features. ATN, an acute injury of renal tubular epithelial cells, occurs more often in deceased donor transplants (Tx) due to ischemia and nephrotoxic drugs.[a]Distinguishing ATN from an acute immunological rejection [AMR or cellular] immediately after the Tx is crucial yet challenging, due to the possibility of both occurring simultaneously. The delay in anti-rejection treatment could result in an irreversible damage to the allograft. A 42-year-old male received a kidney from an ABO compatible, HLA mismatched, deceased donor. Although, HLA DSAs of low intensity were present prior to the Tx, flow XM was negative. Two weeks post-Tx, patient experienced acute shutdown of kidney function (eGFR