Masked acute rejection of the graft kidney under the recovery of native kidneys in a patient who underwent simultaneous liver and kidney transplantation

INTRODUCTION: Simultaneous liver and kidney transplantation is a life‐saving procedure for patients with liver failure and irreversible renal dysfunction. However, some studies have reported the recovery of native renal function after simultaneous liver and kidney transplantation. CASE PRESENTATION: A 33‐year‐old woman initially underwent living‐donor liver transplantation for liver failure. When graft liver failure developed, she also sustained acute renal failure and required continuous hemodiafiltration for 6 weeks. Simultaneous liver and kidney transplantation from a brain‐dead donor recovered her liver and renal function. A 1‐year protocol graft kidney biopsy revealed acute cellular rejection despite stable serum creatinine levels. Renal scintigraphy showed functional native kidneys masking acute rejection of the graft kidney. The rejection was improved by pulse steroid therapy. CONCLUSION: Acute rejection of the graft kidney may silently progress due to recovery of the native kidney function after simultaneous liver and kidney transplantation. Renal scintigraphy and graft kidney biopsy should be considered even if blood tests indicate stable total renal function.