Loss of a renal graft due to recurrence of anti-GBM disease despite rituximab therapy

:  The recurrence of anti-glomerular basement membrane (anti-GBM) glomerulonephritis (GN) in renal transplants is very rare. We report on a patient that developed acute renal allograft dysfunction due to anti-GBM GN relapse 18 months after transplantation. As plasmaseperation, dose escalation of MMF, steroids and cyclophosphamids did not result in an improvement of the graft function, a therapy with the anti-CD20 antibody Rituximab was established in addition to plasmaseperation, cyclophosphamid and steroids. Although this resulted in a decrease of anti-GBM antibody titer, graft function deteriorated further and a renal replacement therapy had to be initiated.