Antibody-mediated rejection following transplantation from an HLA-identical sibling.
Putative antibody-mediated rejection (AMR) in HLA-identical sibling transplantation has rarely been reported and occurred before routine calcineurin inhibitor use. A 29-year-old male developed allograft dysfunction following an HLA-identical renal transplant from his sibling. A pretransplant panel-reactive antibody (PRA) was elevated, pre-transplant crossmatch was negative and no donor-specific antibody (DSA) was identified. Induction with alemtuzumab was followed by maintenance immunosuppression with corticosteroids, tacrolimus and mycophenolate. A biopsy for allograft dysfunction suggested AMR, but DSA could not be detected. Treatment for rejection was transiently successful. Undetectable minor histocompatibility antibodies may have contributed.
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Carrie A
CA
Grafft
Lynn D
LD
Cornell
James M
JM
Gloor
Fernando G
FG
Cosio
Manish J
MJ
Gandhi
Patrick G
PG
Dean
Mark D
MD
Stegall
Hatem
H
Amer
D000328:Adult; D001706:Biopsy; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D035781:Siblings; D014184:Transplantation, Homologous
D006680:HLA Antigens