A case of acute vascular rejection caused by endothelial-reactive non-HLA antibodies.
We describe a female patient who, despite negative conventional cross-matches, lost her first kidney graft in an acute humoral rejection. Prior to the second, AB0-incompatible (A1B to A1) living-donor kidney transplant, the patient had negative T- and B-cell cross-matches but had a positive donor-reactive endothelial cell cross-match. Following pre-transplant protein A and GlycoSorb-ABO immunoadsorptions to remove blood group B and anti-endothelial cell antibodies, Mabthera, and IVIG administrations, she was successfully transplanted. By the second post-operative day, creatinine levels were down to 96 micromol/L from 611 micromol/L pre-operatively. On day 9 creatinine rose again, and on the same day the endothelial cell crossmatch became positive for IgG, whereas the T-cell cross-match remained negative and the anti-A1B titers remained low. A kidney biopsy taken on day 10 post-transplant showed a picture of an acute vascular, antibody-mediated rejection. Following rejection treatment and repeated protein A and Glyco-Sorb-ABO immunoadsorptions, the patient's kidney function was again normalized. The use of a recently developed kit (XM-ONE) for the detection of anti-endothelial cell antibodies allowed us to identify a patient at risk for developing acute antibody-mediated rejection as well as to monitor treatment efficacy and post-transplant complications.
Holgersson
Jan
J
Division of Clinical Immunology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden.
Elsheikh
Elzafir
E
Grufman
Per
P
Sumitran-Holgersson
Suchitra
S
Tydén
Gunnar
G
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000601:surgery*; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D006435:Renal Dialysis; D012086:Reoperation
D007518:Isoantibodies; D003404:Creatinine