Kidney transplantation in a recipient with anti-HLA antibody IgM positive.
In general, anti-HLA antibody belongs to the IgG subclass, but there are very few reports of detection of anti-HLA IgM antibodies. In the present study, we report a renal transplant recipient with a positive NIH-complement dependent cytotoxicity (NIH-CDC) test. The patient was a 24-year-old male with focal segmental glomerulosclerosis (FSGS) as the underlying kidney disease. He had been on maintenance hemodialysis since December 2003 and finally received a living-donor allograft from his mother in October 2008. Pre-transplantation, the NIH-CDC test was positive for both B and T cells, but the flow-cytometric crossmatch test (FCXM) was negative for both cells. The result of the panel-reactive antibody assay (PRA)-single beads test using anti-IgM antibody as the second antibody demonstrated that the positive NIH-CDC test was due to the presence of anti-HLA IgM antibody against the donor-specific antigen A24. Biopsy specimens showed thrombus formation in a small number of glomeruli immediately after the transplantation, but this finding was no longer seen at three months postoperatively. We report successful renal transplantation in a case with anti-HLA IgM antibody.
Department of Urology, Tokyo Women's Medical University, Japan.
Mari
M
Suzuki
Hideki
H
Ishida
Tomonori
T
Komatsu
Takafumi
T
Kennoki
Tsutomu
T
Ishizuka
Kazunari
K
Tanabe
D000328:Adult; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000276:immunology; D015234:HLA-A Antigens / Q000276:immunology* / Q000378:metabolism; D059871:HLA-A24 Antigen; D006650:Histocompatibility Testing; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000276:immunology / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
D005938:Glucocorticoids; D015234:HLA-A Antigens; D059871:HLA-A24 Antigen; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone