title: Acute Antibody-Mediated Rejection in Presence of MICA-DSA and Successful Renal Re-Transplant with Negative-MICA Virtual Crossmatch.
abstract: The presence of donor-specific alloantibodies (DSAs) against the MICA antigen results in high risk for antibody-mediated rejection (AMR) of a transplanted kidney, especially in patients receiving a re-transplant. We describe the incidence of acute C4d+ AMR in a patient who had received a first kidney transplant with a zero HLA antigen mismatch. Retrospective analysis of post-transplant T and B cell crossmatches were negative, but a high level of MICA alloantibody was detected in sera collected both before and after transplant. The DSA against the first allograft mismatched MICA*018 was in the recipient. Flow cytometry and cytotoxicity tests with five samples of freshly isolated human umbilical vein endothelial cells demonstrated the alloantibody nature of patient's MICA-DSA. Prior to the second transplant, a MICA virtual crossmatch and T and B cell crossmatches were used to identify a suitable donor. The patient received a second kidney transplant, and allograft was functioning well at one-year follow-up. Our study indicates that MICA virtual crossmatch is important in selection of a kidney donor if the recipient has been sensitized with MICA antigens.
authors.affiliation: Center for Organ Transplantation, the Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Yingzi
authors.initials: Y
authors.lastname: Ming
authors.affiliation: HLA Histocompatibility Laboratory, Department of Immunology, Xiangya School of Medicine, Center South University, Changsha, Hunan, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Hu
authors.affiliation: HLA Histocompatibility Laboratory, Department of Immunology, Xiangya School of Medicine, Center South University, Changsha, Hunan, China.
authors.forename: Qizhi
authors.initials: Q
authors.lastname: Luo
authors.affiliation: Department of Urology Surgery, Xiangya Hospital, Center South University, Changsha, Hunan, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Ding
authors.affiliation: HLA Histocompatibility Laboratory, Department of Immunology, Xiangya School of Medicine, Center South University, Changsha, Hunan, China.
authors.forename: Weiguang
authors.initials: W
authors.lastname: Luo
authors.affiliation: Center for Organ Transplantation, the Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Zhuang
authors.affiliation: HLA Histocompatibility Laboratory, Department of Immunology, Xiangya School of Medicine, Center South University, Changsha, Hunan, China; The Cooperative Innovation Center of Engineering and New Products for Developmental Biology of Hunan Province, Changsha, Hunan, China.
authors.forename: Yizhou
authors.initials: Y
authors.lastname: Zou
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000097:blood* / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000097:blood* / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged
chemical_list: D015395:Histocompatibility Antigens Class I; D007518:Isoantibodies; C099187:MHC class I-related chain A