Serial ^99mTc-DMSA scintigraphy shows stable renal graft: native kidneys divided function at 1 and 4 years after preemptive combined liver and kidney transplantation, in AFib E526. (A-B) Serial ^99mTc-DMSA scintigraphy in an AFib E526V patient who received preemptive combined liver and kidney transplantation at stage 5 CKD, 1 month before scheduled commencement of hemodialysis. (A) Posterior view of dynamic renal scintigraphy at 1 year after combined liver and kidney function, 3 hours after injection of 80 MBq ^99mTc-DMSA. Regions of interest (ROI; circles) shown are used in the calculation of divided function. The percentage of divided function is as follows: transplant kidney 86% and total native 14%. (B) DMSA scintigraphy in the same patient at 4 years after LKT. The panel shows posterior view scintigraphy 3 hours after injection of 80 MBq ^99mTc-DMSA, and same regions of interest are used in the calculation of divided function. The percentage of divided function is as follows: transplant kidney 87% and total native kidney function 13%. We have confirmed by mass spectrometry¹⁹  in this patient that variant fibrinogen A α-chain has been completely eliminated from the plasma and is replaced by normal (wild-type) fibrinogen A α-chain after LKT.