Successful renal transplantation despite low levels of donor-specific HLA class I antibody without IVIg or plasmapheresis.
We prospectively transplanted 10 primary kidney recipients with deceased donor organs (nine kidney and one pancreas/kidney) when their flow cytometric T-cell IgG, HLA class I donor-specific crossmatch was positive but the AHG T-cell crossmatch was negative, with a median follow-up of 1.8 yr. No pre- or peri-operative IVIg or plasmapheresis was administered to any patient. All but one of the 11 organs transplanted into patients with a flow T(+)/AHG(-) crossmatch is currently functioning despite the continued presence of circulating low levels of HLA class I antibody. Flow HLA class I antigen-coated beads showed the presence of at least one donor-specific HLA class I antibody at transplantation in each of the 10 cases. No rejections were observed in seven of the 10 cases (70%). Six rejection episodes, four cellular and two humoral, occurred in three patients. Each rejection was successfully treated. The only graft loss occurred in a kidney recipient on day 667 secondary to ischemia to the kidney because of cardiac surgery. Thus, short-term (one to two years) graft survival in primary transplants was not influenced by low levels of donor-specific HLA class I antibody present at transplantation and no prophylactic treatment such as IVIg, plasmapheresis, anti-CD20 or splenectomy was needed peri-operatively.
Bryan
Christopher F
CF
Midwest Transplant Network, Westwood, KS 66205-1867, USA. cbryan@mwtn.org
McDonald
Scott B
SB
Luger
Alan M
AM
Shield
Charles F
CF
Winklhofer
Franz T
FT
Michael Borkon
A
A
Warady
Bradley A
BA
Aeder
Mark I
MI
Murillo
Daniel
D
D001787:Blood Group Incompatibility; D006085:Graft Survival; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D011446:Prospective Studies; D016896:Treatment Outcome
D015395:Histocompatibility Antigens Class I; D007518:Isoantibodies