Abstract
IntroductionHyperacute rejection may be prevented by avoiding the transplantation of kidneys into patients with pre-existing anti-donor Class I human leukocyte antigen antibodies. However, the role of anti-donor-Class II-human leukocyte antigen-DQ antibodies is not established. The question is ever more relevant as more sensitive cross-matching techniques detect many additional antibodies during the final crossmatch. We now report successful renal transplantation of a patient who had pre-existing antibodies against his donor's human leukocyte antigen-DQ5.Case presentationOur patient, a Caucasian man, was 34 years of age when he received his first deceased donor renal transplant. After 8 years, his first transplant failed from chronic allograft dysfunction and an earlier bout of Banff 1A cellular rejection. The second deceased donor kidney transplant was initially allocated to the patient due to a 0 out of 6 mismatch. The B cell crossmatch was mildly positive, while the T Cell crossmatch was negative. Subsequent assays showed that the patient had preformed antibodies for human leukocyte antigen DQ5 against his second donor. Despite having preformed antibodies against the donor, the patient continues to have excellent allograft function two years after his second renal transplant.ConclusionThe presence of pre-existing antibodies against human leukocyte antigen DQ5 does not preclude transplantation. The relevance of having other antibodies against class II human leukocyte antigens prior to transplantation remains to be studied.
Highlights
Hyperacute rejection may be prevented by avoiding the transplantation of kidneys into patients with pre-existing anti-donor Class I human leukocyte antigen antibodies
The risk of hyperacute rejection may be greatly reduced by avoiding the transplantation of kidneys into patients with pre-existing high titers of anti-donor Class I human leukocyte antigen (HLA) antibodies [1] a major recent clinical challenge is understanding the role of low titer antibodies against Class I and Class II HLA molecules
We report a successful retransplantation despite pre-existing anti-donor DQ5 antibodies in a donor recipient pair that were zero mismatches at HLA-A, B and C
Summary
As progressively more sensitive techniques become available for the final crossmatch, more HLA antibodies are being detected, and are being detected at lower levels. The clinical challenge is deciding if the detected antibodies should prevent transplantation, or should change the immunosuppression [2,3,4]. One such challenge is determining whether pre-existing anti-donor HLA DQ antibodies increase the risk of acute rejection. Our patient may be uniquely illustrative because he was successfully transplanted despite pre-existing anti-donor HLA-DQ antibodies without plasmapheresis and intravenous immunoimmunoglobulin, and because he was matched at Class I HLA A, B, and C. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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