title: Hyperacute Rejection in a Kidney Transplant With Negative Crossmatch: A Case Report.
abstract: Hyperacute rejection (HAR) is a rare event that can be prevented by crossmatch tests that detect anti-human leukocyte antigen antibodies against the donor. We present the case of a 43-year-old man who underwent a deceased-donor kidney transplantation with a negative complement-dependent cytotoxicity and a negative flow cytometry crossmatch. Luminex technology detected anti-DQ donor-specific antibodies (DSA) with a mean fluorescence intensity of 11,000. A single plasmapheresis session was carried out, followed by immunosuppression with immunoglobulin, antithymocyte globulin, tacrolimus, and methylprednisolone. Minutes after graft reperfusion, in the presence of clinical evidence of HAR, the patient underwent nephrectomy. The investigation for the presence of anti-major histocompatibility complex class I-related chain A and anti-endothelial antibodies was negative. This case reinforces the importance of DSA, and more specifically, of anti-DQ DSA in the allogeneic response when detected by solid-phase tests, even with a negative crossmatch, assuming they can be responsible for HAR.
authors.affiliation: Nephrology and Kidney Transplantation Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal. Electronic address: martashp@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Nephrology and Kidney Transplantation Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Guerra
authors.affiliation: Nephrology and Kidney Transplantation Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Gonçalves
authors.affiliation: Nephrology and Kidney Transplantation Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Santana
authors.affiliation: Nephrology and Kidney Transplantation Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Nascimento
authors.affiliation: Nephrology and Kidney Transplantation Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: A G
authors.initials: AG
authors.lastname: da Costa
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001788:Blood Grouping and Crossmatching; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control / Q000628:therapy; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006683:HLA-DQ Antigens / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009392:Nephrectomy; D010956:Plasmapheresis; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors
chemical_list: D000906:Antibodies; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D006683:HLA-DQ Antigens; D015395:Histocompatibility Antigens Class I; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016559:Tacrolimus; D008775:Methylprednisolone