title: Successful kidney transplantation after desensitization in a patient with positive flow crossmatching and donor-specific anti-HLA-DP antibody: A Case report.
abstract: BACKGROUND
  Traditionally, the presence of antibodies against human leukocyte antigen (HLA)-C and DP was considered to be associated with only a low risk of antibody-mediated rejection (ABMR) in kidney transplantation (KT), because the antigenicities of these proteins are weak. However, the clinical effects of HLA-C and -DP donor-specific HLA antibodies (DSHAs) have recently been reevaluated.
  
  
  METHODS
  Here, we report the case of a retransplant patient with positive flow cytometry crossmatch (FCXM) and high level of HLA-DP DSHA who was desensitized using rituximab, plasmapheresis, and intravenous immunoglobulin.
  
  
  RESULTS
  The epitope-based antibody reactivity was identified that the positive B-cell FCXM in our patient was attributable to the specific epitope. The patient underwent a successful retransplantation and has continued to do well for 10 month after KT.
  
  
  CONCLUSIONS
  If an HLA-DP DSHA is present, it is important to detect any mismatched HLA-DP epitope pretransplantation and to monitor HLA-DP levels carefully. According to previous reports, anti-HLA-DP DSHA can induce ABMR soon after transplantation, but such ABMR can be prevented by pretransplantation desensitization and careful monitoring of DSHA levels.
authors: Department of Transplant Surgery Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors: Seung Hwan
authors: SH
authors: Song
authors: Borae G
authors: BG
authors: Park
authors: Juhan
authors: J
authors: Lee
authors: Myoung Soo
authors: MS
authors: Kim
authors: Yu Seun
authors: YS
authors: Kim
authors: Hyon-Suk
authors: HS
authors: Kim
mesh_terms: D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology*; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D005434:Flow Cytometry; D006682:HLA-DP Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*
chemical_list: D000888:Antibodies, Anti-Idiotypic; D006682:HLA-DP Antigens