Abstract
Patient 46 yo (gravida 6) BF, IgA nephropathy. Pre-transplant LABScreen SA beads (SAB): anti-B57 (MFI = 11,125), B58 (9163), DP1 (1871). Class I and Class II DSA not detected. See Table 1. Virtual-XM predicted negative; deceased donor pre-transplant flow- and CDC-XM were negative. Renal function was poor following transplant. By day 3 post-transplant clinical findings were consistent with AMR. Day 4 renal biopsy revealed patchy C4d+ in peritubular capillaries consistent with AMR. Nephrectomy was performed on post-transplant day 7. Additional assays were performed on pre- and 3 wk post-transplant sera to evaluate for reasons for AMR, including: One Lambda LABScreen SAB assay for C1q; and modified for C1q + AHG, detection of IgM, and use of non-heat inactivated serum for assays; and One Lambda MICA, anti-AT1R, and anti-ETAR antibody assays. See Tables. Results Pre-transplant IgG DSA were negligible. IgM DSA were elevated. Anti-AT1R antibody was elevated. Interpretation: immediate post-transplant humoral rejection correlates with presence of IgM DSA and anti-AT1R (IgG) antibodies. Discussion IgM anti-HLA antibodies are not considered to be relevant for AMR. Anti-AT1R is reported as a cause of acute AMR, but not typically in the immediate post-transplant period. We believe this case argues that IgM DSA appear be relevant, but cannot exclude that either anti-AT1R IgG antibodies alone, or in combination with IgM DSA, may result in AMR. Conclusions IgM DSA and/or anti-AT1R may result in post-transplant humoral rejection, and therefore should be considered in evaluation for episodes of AMR, especially when IgG DSA are negligible. Download : Download full-size image Download : Download full-size image T. Harville: Scientific/Medical Advisor; Company/Organization; Baxter Healthcare, CSL Behring. 7. Other (Identify); Company/Organization; Medical Advisory Board for Arkansas Regional Organ Recovery Agency.
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