[Anti-HLA antibodies after bone graft and their impact on kidney transplant programs].
Immunological evaluation by panel reactive antibody (PRA) and determination of anti-HLA specificity is an important phase in the assessment of patients awaiting kidney transplant. The main causes of immunization are previous solid organ transplants, blood transfusions, and pregnancy; immunogenicity can also be triggered by vascularized tissue grafts. Immune induction by cryopreserved bone allografts is not yet fully understood. We report the case of a 19-year-old patient with osteosarcoma who underwent resection of the left proximal tibia with reconstruction using human bone in 1997 (donor typing: A3, A29 (19) - B44 (12), Bw4 - DR13 (6), DR7, DR52, DR53). The patient was subsequently placed on the waiting list for a cadaver donor kidney transplant because of chronic kidney failure caused by cisplatin toxicity. Pretransplant immunological screening using the CDC (complement dependent cytotoxicity) technique revealed a PRA of 63% and anti-A3 and anti-A68 antibodies. The presence of IgG antibody specificity against class I and class II donor antigens (specifically anti-A3, B44, DR7 antibodies) was highlighted using flow cytometry (Tepnel-Luminex). Further immunological studies using single HLA specificity analysis (LSA Class I - II - Tepnel-Luminex) detected direct antibodies against all donor antigen specificities. This is the first reported case of immune induction after a bone graft in a kidney transplant candidate. It underlines the importance of the availability of HLA typing data of all human allograft donors.
Mosconi
G
G
U.O. di Nefrologia, Dialisi e Trapianto, Policlinico Universitario S. Orsola, Bologna 40138, Italy. nefrolab@aosp.bo.it
Baraldi
O
O
Fantinati
C
C
Cappuccilli
M L
ML
Corsini
S
S
Zanelli
P
P
Bassi
A
A
Buscaroli
B
B
Feliciangeli
G
G
Stefoni
S
S
D001859:Bone Neoplasms / Q000601:surgery; D016025:Bone Transplantation / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000276:immunology* / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D012516:Osteosarcoma / Q000601:surgery; D011300:Preoperative Care; D013977:Tibia / Q000601:surgery; D055815:Young Adult
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D002945:Cisplatin