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Title: | Hidden perils in a highly sensitized kidney transplant recipient. | Authors: | Mulley W. ;Ford S.;Summers S.;Cantwell L. | Institution: | (Ford, Summers, Mulley) Department of Nephrology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia (Summers, Mulley) Department of Medicine, Monash University, Clayton, VIC, Australia (Cantwell) Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, South Melbourne, VIC, Australia | Issue Date: | 26-Apr-2012 | Copyright year: | 2012 | Publisher: | Blackwell Publishing (550 Swanston Street, Carlton South VIC 3053, Australia) | Place of publication: | Australia | Publication information: | Nephrology. 17 (SUPPL. 1) (pp 9-11), 2012. Date of Publication: April 2012. | Abstract: | Highly sensitised patients are at increased risk for antibody mediated rejection (AMR) and reduced graft survival. Highly sensitive assays for detecting recipient preformed anti-HLA antibodies have been developed and identify high immunological risk donors. A 62yo male with end stage renal failure secondary to glomerulonephritis received a T-cell crossmatch negative, deceased donor, renal transplant mismatched at 3 of 6 HLA loci. A donor specific antibody (DSAb) to DR17 (MFI 2073) was present. Given his advancing age, multiple medical comorbidities and broad HLA sensitisation the transplant was accepted, however, shortly before transplantation two atypical results were made available. Firstly a B-cell crossmatch was performed and found to be negative in current serum but strongly positive in peak serum, secondly a further potential DSAb was predicted based on linkage disequilibrium with known donor HLA typing. The donor HLA typing would not be clarified until after the transplant. Despite the increased risk of AMR the transplant proceeded with pre-emptive plasma exchange. The patient developed severe AMR requiring extensive therapy. Incomplete prospective donor HLA typing can generate uncertainty in the interpretation of the virtual crossmatch performed for deceased donor transplants. This may result in clinically relevant sequelae. Advances in antibody detection techniques need to be matched by timely donor HLA typing for its full benefit to be realised. © 2012 The Authors Nephrology © 2012 Asian Pacific Society of Nephrology. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/j.1440-1797.2012.01584.x | PubMed URL: | 22497647 [http://www.ncbi.nlm.nih.gov/pubmed/?term=22497647] | ISSN: | 1320-5358 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/28209 | Type: | Article | Subjects: | male priority journal symptom basiliximab/dt [Drug Therapy] HLA antibody/ec [Endogenous Compound] *HLA antigen/ec [Endogenous Compound] immunoglobulin/dt [Drug Therapy] immunoglobulin/iv [Intravenous Drug Administration] methylprednisolone/dt [Drug Therapy] mycophenolic acid 2 morpholinoethyl ester/dt [Drug Therapy] rituximab/dt [Drug Therapy] tacrolimus/dt [Drug Therapy] *kidney graft rejection/dt [Drug Therapy] adult antibody detection article case report clinical feature graft recipient HLA typing human kidney failure/su [Surgery] kidney graft kidney graft rejection/dt [Drug Therapy] *kidney graft rejection/co [Complication] *kidney graft rejection/pc [Prevention] *kidney graft rejection/su [Surgery] kidney transplantation kidney graft kidney graft rejection / drug therapy *kidney graft rejection / *complication / *drug therapy / *prevention / *surgery kidney transplantation male priority journal adult symptom antibody detection article case report clinical feature graft recipient HLA typing human kidney failure / surgery |
Type of Clinical Study or Trial: | Case series or case report |
Appears in Collections: | Articles |
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