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Probable C 4d‐negative accelerated acute antibody‐mediated rejection due to non‐ HLA antibodies
Author(s) -
Niikura Takahito,
Yamamoto Izumi,
Nakada Yasuyuki,
Kamejima Sahoko,
Katsumata Haruki,
Yamakawa Takafumi,
Furuya Maiko,
Mafune Aki,
Kobayashi Akimitsu,
Tanno Yudo,
Miki Jun,
Yamada Hiroki,
Ohkido Ichiro,
Tsuboi Nobuo,
Yamamoto Hiroyasu,
Yokoo Takashi
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12467
Subject(s) - medicine , antibody , rituximab , panel reactive antibody , gastroenterology , transplantation , kidney transplantation , creatinine , immunology , abo blood group system , human leukocyte antigen , pathology , antigen
Abstract We report a case of probable C 4d‐negative accelerated acute antibody‐mediated rejection due to non‐ HLA antibodies. A 44 year‐old male was admitted to our hospital for a kidney transplant. The donor, his wife, was an ABO minor mismatch (blood type O to A) and had G itelman syndrome. Graft function was delayed; his serum creatinine level was 10.1 mg/d L at 3 days after transplantation. Open biopsy was performed immediately; no venous thrombosis was observed during surgery. Histology revealed moderate peritubular capillaritis and mild glomerulitis without C 4d immunoreactivity. Flow cytometric crossmatching was positive, but no panel‐reactive antibodies against HLA or donor‐specific antibodies ( DSA bs) to major histocompatibility complex class I ‐related chain A ( MICA ) were detected. Taken together, we diagnosed him with probable C 4d‐negative accelerated antibody‐mediated rejection due to non‐ HLA , non‐ MICA antibodies, the patient was treated with steroid pulse therapy (methylprednisolone 500 mg/day for 3 days), plasma exchange, intravenous immunoglobulin (40 g/body), and rituximab (200 mg/body) were performed. Biopsy at 58 days after transplantation, at which time S ‐ C r levels were 1.56 mg/d L , found no evidence of rejection. This case, presented with a review of relevant literature, demonstrates that probable C 4d‐negative accelerated acute AMR can result from non‐ HLA antibodies.