title: Positive pre-transplant flow-panel reactive antibody detected after accelerated acute rejection with negative pre-transplant flow crossmatch.
abstract: A 30-yr-old woman underwent kidney transplantation from a flow cytometric lymphocyte crossmatch-negative donor. Immunosuppression consisted of tacrolimus, mycophenolate mofetil, basiliximab and three days of steroid. On day 5 post-transplant, she developed acute rejection and underwent anti-rejection therapy consisting of steroid pulse and deoxyspurgualin. Retrospective analyses of anti-human leukocyte antigen antibody revealed high flow panel reactive antibody (PRA) in the pre-transplant serum without donor specific antibody (DSA) and positive DSA at the time of rejection. Anti-rejection therapy was successful in treating cellular rejection but her graft function further deteriorated after three months post-transplant and graft biopsy revealed chronic allograft nephropathy with positive staining for C4d in peritubular capillary, suggesting the presence of chronic antibody-mediated rejection. Pre-transplant positive flow PRA without DSA may also be a risk for acute and chronic rejection.
authors.affiliation: Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. miumiu@med.hokudai.ac.jp
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Miura
authors.forename: Kanako C
authors.initials: KC
authors.lastname: Kubota
authors.forename: Tomoo
authors.initials: T
authors.lastname: Itoh
authors.forename: Takenori
authors.initials: T
authors.lastname: Ono
authors.forename: Ken
authors.initials: K
authors.lastname: Morita
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watarai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Harada
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hirano
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D011237:Predictive Value of Tests; D012307:Risk Factors