HLA incompatible combined liver-kidney transplantation: dynamics of antibody modulation revealed by a novel approach to HLA antibody characterisation.
This case report confirms the utility of simultaneous liver transplantation in allowing successful kidney transplantation in the face of preformed, high levels of DSA, which would under normal circumstances be associated with hyperacute rejection and kidney graft failure. Antibody characterisation in terms of epitope specificity is more accurate and informative than antibodies described as "antigen-specific" and we suggest a method for identifying and tracking these antibodies; i.e. follow the epitope reaction not the antigen reactions. We consider that this will give a better insight into the behaviour and pathogenicity of HLA-specific sera. In the case presented here this approach has revealed some novel features of the post transplant antibody response in a sensitised recipient. These illustrate three phenomena which challenge current dogmas; an early resynthesis of DSA does not necessarily cause AMR, high levels of DSA can spontaneously modulate, and measurement of antibodies in terms of antigen specificity can give misleading results.
H&I Laboratory, NHSBT Birmingham Centre, Vincent Drive, Edgbaston, Birmingham B15 2SG, UK. Electronic address: lowedavep@gmail.com.
David
D
Lowe
Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Shazia
S
Shabir
Department of Liver Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
John
J
Buckels
Department of Liver Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Paolo
P
Muiesan
Department of Hepatology and Liver Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Geoffrey
G
Hayden
Department of Hepatology and Liver Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Andrew
A
Holt
Department of Kidney Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Ahmed
A
Hamsho
Department of Pathology, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Kassi
K
Skordilis
Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Graham
G
Lipkin
Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, B15 2WB, UK.
Richard
R
Borrows
H&I Laboratory, NHSBT Birmingham Centre, Vincent Drive, Edgbaston, Birmingham B15 2SG, UK.
David
D
Briggs
D000208:Acute Disease; D000328:Adult; D000917:Antibody Formation; D000939:Epitopes / Q000276:immunology / Q000378:metabolism; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology / Q000378:metabolism; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007114:Immunization; D056747:Immunomodulation; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D007690:Polycystic Kidney Diseases / Q000276:immunology / Q000628:therapy*; D012698:Serologic Tests / Q000379:methods*
D000939:Epitopes; D006680:HLA Antigens; D007518:Isoantibodies
Combined liver–kidney transplantation; Crossmatching; Epitope; HLA-specific antibody