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- Title
Probable C4d-negative accelerated acute antibody-mediated rejection due to non- HLA antibodies.
- Authors
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
- Abstract
We report a case of probable C4d-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 Gitelman 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 C4d immunoreactivity. Flow cytometric crossmatching was positive, but no panel-reactive antibodies against HLA or donor-specific antibodies ( DSAbs) to major histocompatibility complex class I-related chain A ( MICA) were detected. Taken together, we diagnosed him with probable C4d-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- Cr levels were 1.56 mg/d L, found no evidence of rejection. This case, presented with a review of relevant literature, demonstrates that probable C4d-negative accelerated acute AMR can result from non- HLA antibodies.
- Subjects
CD4 antigen; HLA histocompatibility antigens; KIDNEY transplantation; GITELMAN syndrome; BLOOD donors
- Publication
Nephrology, 2015, Vol 20, p75
- ISSN
1320-5358
- Publication type
Article
- DOI
10.1111/nep.12467