Make the grade for XXXX after kidney transplantation.

@entity1 @entity1333 @entity2883 @entity631 @entity454
Antineutrophil cytoplasmic antibodies-associated @entity1333 (AAV) is a well-described cause of multiple organ involvement including rapidly progressive pauci-immune crescentic @entity631 . Kidney transplantation (KTx) is considered the treatment of choice in @entity1 with @entity454 ( @entity454 ) due to AAV. @entity1 and graft survival in AAV after KTx is favourable and comparable with other non-diabetic causes of @entity454 . While relapse of AAV is high in dialysis @entity1 (up to 50%), it decreases after KTx (8.6-22.2%). Yet, relapse may occur at any time after KTx and transplant involvement has been documented in at least 25 cases. Therapeutic guidelines for the management of AAV after KTx do not exist and clinical management is a controversial discussion. We present two unusual cases of young males with smouldering AAV who recently underwent KTx at our hospital. Case 1 experienced repeated relapses after KTx and was finally successfully treated with rituximab. Case 2 received rituximab pre-emptively before living kidney donation and remained free of flairs. Prompted by theses two cases, we reviewed the literature focusing on the right point of time for transplantation, risk assessment, role of antineutrophil cytoplasmic antibodies, clinical presentation of flairs and immunosuppression in smouldering @entity2883 ( @entity2883 ) and in relapse, including individualized treatment with rituximab.
