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173-P:RECYCLING ALLOGRAFT KIDNEYS: MONITORING FOR HLA ANTIBODIES

Authors
Journal
Human Immunology
0198-8859
Publisher
Elsevier
Volume
73
Identifiers
DOI: 10.1016/j.humimm.2012.07.299
Disciplines
  • Medicine

Abstract

Aim Rarely are allografts reused following the death or critical unsuitability of the allograft in the original recipient. The “recycled” allograft carries not only the risk for sensitization against the donor HLA antigens, but also the possibility for HLA antibody production against the HLA antigens of the original recipient via passenger leukocytes. We describe here the case of a female recipient of an allograft kidney that had been previously transplanted and HLA antibodies against the donor and first recipient were detected. Methods HLA antibodies were assayed by LabScreen kits. Results The patient, an 48 year-old African American woman (HLA:A23,74; B7,14(Bw6,-); DR14,18; DQ4,6; DR52,-) was transplanted in 1996. The kidney donor was a 45 year-old male (HLA:A3,32; B7,44(Bw4,6); DR4,6; DQ3,-; DR53,-) originally transplanted in 1992 to a 58 year-old female (1st recipient HLA:A2,32; B44,57(Bw4,-); DR4,7; DQ3,-; DR53,-). Her post-transplant course was largely uneventful over 16 years with only three biopsy-proven rejection episodes (in 1996, 2004 and 2005) but without HLA antibody testing. Recent follow-up (>16 years post-transplant) showed evidence of both cellular and humoral rejection in conjunction with a possible history of non-adherence. At this time, HLA antibody monitoring was performed by Single Antigen testing, revealing reactivity to the donor B44 and DQ3 antigens. Interestingly, other HLA antibody specificities were also identified and showed reactivity to the first recipient (A2, B57, DR7). Other potential routes of HLA antigen sensitization were identified (including 3 blood transfusions in 2012 3 months before antibody testing), but no pregnancy information was available and could not be ruled out. Conclusions While we were unable to directly associate the non-donor specific HLA antibodies with the first recipient, antibody testing in this case suggests that passenger leukocytes might contribute to allo-sensitization when a donor allograft is used in multiple recipients.

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