New horizons in transplantationCase reportAcute Rejection of a Kidney Transplant in a Patient With Common Variable Immunodeficiency: A Case Report

•There are only a few published reports of patients with common variable immunodeficiency who have undergone solid organ transplantation.•We describe the clinical course of a patient with common variable immunodeficiency who underwent kidney transplantation.•This case shows that acute rejection remains a concern despite immunodeficiency.

Common variable immunodeficiency is a primary immunodeficiency characterized by hypogammaglobulinemia and recurrent bacterial infections. We report a case of a 44-year-old male patient with end-stage renal disease and an established diagnosis of common variable immunodeficiency who underwent a living unrelated kidney transplant. He remained nearly infection free on maintenance immunoglobulin replacement. However, his posttransplant course was complicated by acute rejection that ultimately led to allograft loss. This case illustrates the challenge of transplantation in this patient population because of the delicate balance that must be achieved between maintaining adequate immunosuppression and minimizing the risk of infection.