A renal transplant recipient on tacrolimus and mycophenolate develops a rising serum creatinine on day 8 post-transplant. Biopsy shows dense mononuclear cell infiltration of tubular epithelium with tubulitis. Panel reactive antibody (PRA) was 12% pre-transplant. Which type of rejection is this?
- A Hyperacute rejection
- B Antibody-mediated rejection (AMR)
- C Acute T-cell mediated (cellular) rejection ✓
- D Chronic allograft nephropathy
Correct answer: C. Acute T-cell mediated (cellular) rejection
Explanation
Acute T-cell mediated rejection (TCMR) occurs days to weeks post-transplant and is characterised histologically by tubulitis (inflammatory cells within tubular epithelium) and interstitial mononuclear infiltration. Hyperacute rejection occurs within minutes due to pre-formed antibodies (high PRA), which is not the case here. Antibody-mediated rejection shows peritubular capillaritis, C4d deposition, and DSA. Chronic allograft nephropathy occurs over months to years.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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