Abstract：
Patients who are HLA-sensitized are at high risk for early antibody-mediated rejection (AMR) and worse outcomes. Therefore, it is crucial to detect the presence of donor-specific antibodies (DSAs) using pretransplant antibody identification and crossmatch assays. An error in antibody identification can lead to disastrous clinical outcomes. We present a case of acute AMR associated with preformed HLA-DPα and HLA-DPβ DSAs that were not identified before transplantation.
A 27-year-old woman received a second kidney transplant from a deceased donor. Her pretransplant panel-reactive antibody level was 94%. The complement-dependent cytotoxicity crossmatch was negative for T and B cells at the time of transplantation. She experienced early acute AMR proven by a kidney biopsy. Single antigen bead testing of the patient\'s serum at the time of rejection as well as the pre-second transplant serum revealed strong antibodies against the DPA1*01:03 and DPB1*02:01 alleles in the second donor. These antibodies were not identified by phenotypic bead assay during the patient\'s time on the waiting list. The patient was treated with plasmapheresis and anti-thymocyte globulin. However, she experienced abdominal pain on day 37 post-transplantation. Surgical exploration revealed a laceration on the transplanted kidney, which was then repaired. Subsequently, infected hematoma was suspected and the transplanted kidney was removed.
The present case highlights the clinical significance of preformed HLA-DPα and HLA-DPβ DSAs. Accuracy in determination of HLA antibodies before transplantattion is critical for transplant outcome. HLA-DP typing and single antigen bead testing are recommended for a precise antibody interpretation, especially in highly sensitized patients. Careful interpretation of antibody testing results is essential for the success of organ transplantation.
A 27-year-old woman received a second kidney transplant from a deceased donor. Her pretransplant panel-reactive antibody level was 94%. The complement-dependent cytotoxicity crossmatch was negative for T and B cells at the time of transplantation. She experienced early acute AMR proven by a kidney biopsy. Single antigen bead testing of the patient\'s serum at the time of rejection as well as the pre-second transplant serum revealed strong antibodies against the DPA1*01:03 and DPB1*02:01 alleles in the second donor. These antibodies were not identified by phenotypic bead assay during the patient\'s time on the waiting list. The patient was treated with plasmapheresis and anti-thymocyte globulin. However, she experienced abdominal pain on day 37 post-transplantation. Surgical exploration revealed a laceration on the transplanted kidney, which was then repaired. Subsequently, infected hematoma was suspected and the transplanted kidney was removed.
The present case highlights the clinical significance of preformed HLA-DPα and HLA-DPβ DSAs. Accuracy in determination of HLA antibodies before transplantattion is critical for transplant outcome. HLA-DP typing and single antigen bead testing are recommended for a precise antibody interpretation, especially in highly sensitized patients. Careful interpretation of antibody testing results is essential for the success of organ transplantation.
摘要：
HLA致敏的患者具有早期抗体介导的排斥反应（AMR）和更差的结果的高风险。因此,使用移植前抗体鉴定和交叉匹配测定来检测供体特异性抗体(DSA)的存在是至关重要的.抗体鉴定中的错误可能导致灾难性的临床结果。我们介绍了一例与移植前未发现的预制HLA-DPα和HLA-DPβDSA相关的急性AMR。
一名27岁的妇女接受了死者捐献者的第二次肾脏移植。她的移植前小组反应性抗体水平为94％。在移植时,补体依赖性细胞毒性交叉匹配对于T细胞和B细胞是阴性的。她经历了肾脏活检证实的早期急性AMR。在排斥反应时对患者血清以及第二次移植前血清进行的单抗原珠测试揭示了针对第二供体中DPA1*01:03和DPB1*02:01等位基因的强抗体。在等待名单上的患者时间期间,通过表型珠测定未鉴定这些抗体。患者接受血浆置换和抗胸腺细胞球蛋白治疗。然而,她在移植后第37天出现腹痛.手术探查显示移植的肾脏有裂伤,然后修复。随后，怀疑感染的血肿，并切除了移植的肾脏。
本病例强调了预先形成的HLA-DPα和HLA-DPβDSAs的临床意义。移植前确定HLA抗体的准确性对于移植结果至关重要。HLA-DP分型和单抗原珠测试被推荐用于精确的抗体解释。特别是在高度敏感的患者中。仔细解释抗体检测结果对于器官移植的成功至关重要。
一名27岁的妇女接受了死者捐献者的第二次肾脏移植。她的移植前小组反应性抗体水平为94％。在移植时,补体依赖性细胞毒性交叉匹配对于T细胞和B细胞是阴性的。她经历了肾脏活检证实的早期急性AMR。在排斥反应时对患者血清以及第二次移植前血清进行的单抗原珠测试揭示了针对第二供体中DPA1*01:03和DPB1*02:01等位基因的强抗体。在等待名单上的患者时间期间,通过表型珠测定未鉴定这些抗体。患者接受血浆置换和抗胸腺细胞球蛋白治疗。然而,她在移植后第37天出现腹痛.手术探查显示移植的肾脏有裂伤,然后修复。随后，怀疑感染的血肿，并切除了移植的肾脏。
本病例强调了预先形成的HLA-DPα和HLA-DPβDSAs的临床意义。移植前确定HLA抗体的准确性对于移植结果至关重要。HLA-DP分型和单抗原珠测试被推荐用于精确的抗体解释。特别是在高度敏感的患者中。仔细解释抗体检测结果对于器官移植的成功至关重要。
