P149 Pancreas after kidney transplant – Can the kidney close the door of opportunity?

Abstract

Aim Sensitization events such as blood product transfusion, pregnancy and transplantation can change the HLA antibody profile of patients in its specificity and strength. Here we report a case of HLA class I and II negative antibody screened patient who received a kidney and within only 10 days of transplant was tested crossmatch positive with pancreas potential donor. Methods The antibody profile was evaluated using both LABScreen PRA and LABScreen single antigens (SA) beads (One Lambda, Inc.). The crossmatch was performed using pronase treated T cell and B cell IgG flow cytometry crossmatch (FCXM). FCXM was consider positive when the T cell and B cell were more than 38 and more than 50 MCS respectively. Results Historical serum,five months before Kidney transplant was positive for HLA class I only and the highest MFI was 2083 MFI with no DSA against the received kidney.Patient serum at the time of Kidney transplant was negative for HLA class I and II. Patients serum tested ten days post kidney transplant (at the time of pancreas offer) was positive for HLA class I only with anti B13 (10574 MFI) DSA against the offered pancreas and not DSA to the transplanted kidney. The anti B13 DSA was also present in the historical serum (five months before Kidney transplant) with only 855 MFI. FCXM with the potential pancreas donor was positive for T-cell (+336 MCS) and B (+246 MCS) for the current serum and completely negative for the previous serum which was ten days earlier. Conclusion This case highlights the strength of the immune memory cells and the need to always consider the historical antibody profile of the patients in risk assessment of the transplant. Furthermore, transplanting patients who are fit for simultaneous pancreas-kidney transplantation with kidney than pancreas may trigger immune response that ultimately hindered pancreas transplant difficult.