title: Primary Graft Dysfunction After Zero-Mismatch Kidney Transplantation Secondary to Early Biopsy-Proven Acute Cell-Mediated Rejection: Case Report.
abstract: We report a case of primary renal allograft dysfunction and early acute cell-mediated rejection after a 12/12 HLA antigen zero-mismatch (0MM) transplant. The recipient was a 40-year-old white man who was highly allosensitized, with a calculated panel reactive antibody score of 100%. In posteroperative day 1 the recipient remained anuric and underwent dialysis because of hyperkalemia. Graft biopsy showed early acute cellular rejection, Banff grade 2B. No evidence of antibody-mediated rejection was observed. To our knowledge, this case is the 1st to report early cell-mediated rejection after 12/12 HLA antigen 0MM kidney transplantation. This case suggests that highly sensitized candidates are at high immunologic risk even in the context of 0MM kidney transplantation.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: elfadan@ccf.org.
authors.forename: N
authors.initials: N
authors.lastname: Elfadawy
authors.affiliation: Unidad de Inmunología e Histocompatibilidad, Hospital Durand, Buenos Aires, Argentina.
authors.forename: G
authors.initials: G
authors.lastname: Diaz
authors.affiliation: Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: A
authors.initials: A
authors.lastname: Chiesa-Vottero
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: S
authors.initials: S
authors.lastname: Nurko
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: E
authors.initials: E
authors.lastname: Poggio
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: S
authors.initials: S
authors.lastname: Flechner
authors.affiliation: Allogen Laboratories, Cleveland Clinic, Cleveland, Ohio.
authors.forename: L
authors.initials: L
authors.lastname: Klingman
authors.affiliation: Allogen Laboratories, Cleveland Clinic, Cleveland, Ohio.
authors.forename: D
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Allogen Laboratories, Cleveland Clinic, Cleveland, Ohio.
authors.forename: A
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Allogen Laboratories, Cleveland Clinic, Cleveland, Ohio.
authors.forename: M
authors.initials: M
authors.lastname: Askar
mesh_terms: D000328:Adult; D001706:Biopsy; D005434:Flow Cytometry; D005922:Glomerulonephritis, IGA / Q000276:immunology / Q000601:surgery*; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D055031:Primary Graft Dysfunction / Q000175:diagnosis* / Q000628:therapy; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens