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Successful kidney transplantation after desensitization in a patient with positive flow crossmatching and donor-specific anti-HLA-DP antibody: A Case report

Authors
 Seung Hwan Song  ;  Borae G. Park  ;  Juhan Lee  ;  Myoung Soo Kim  ;  Yu Seun Kim  ;  Hyon-Suk Kim 
Citation
 MEDICINE, Vol.98(32) : 4521, 2016 
Journal Title
 MEDICINE 
ISSN
 0025-7974 
Issue Date
2016
MeSH
Adult ; Antibodies, Anti-Idiotypic/immunology* ; Blood Grouping and Crossmatching/methods* ; Desensitization, Immunologic/methods* ; Female ; Flow Cytometry ; HLA-DP Antigens/immunology* ; Humans ; Kidney Transplantation/methods*
Keywords
desensitization ; donor-specific antibody ; HLA-DP antibody ; kidney transplantation
Abstract
BACKGROUND: Traditionally, the presence of antibodies against human leukocyte antigen (HLA)-C and DP was considered to be associated with only a low risk of antibody-mediated rejection (ABMR) in kidney transplantation (KT), because the antigenicities of these proteins are weak. However, the clinical effects of HLA-C and -DP donor-specific HLA antibodies (DSHAs) have recently been reevaluated. METHODS: Here, we report the case of a retransplant patient with positive flow cytometry crossmatch (FCXM) and high level of HLA-DP DSHA who was desensitized using rituximab, plasmapheresis, and intravenous immunoglobulin. RESULTS: The epitope-based antibody reactivity was identified that the positive B-cell FCXM in our patient was attributable to the specific epitope. The patient underwent a successful retransplantation and has continued to do well for 10 month after KT. CONCLUSION: If an HLA-DP DSHA is present, it is important to detect any mismatched HLA-DP epitope pretransplantation and to monitor HLA-DP levels carefully. According to previous reports, anti-HLA-DP DSHA can induce ABMR soon after transplantation, but such ABMR can be prevented by pretransplantation desensitization and careful monitoring of DSHA levels.
DOI
10.1097/MD.0000000000004521
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Kim, Hyon Suk(김현숙) ORCID logo https://orcid.org/0000-0001-5662-7740
Park, Borae G(박금보래)
Song, Seung Hwan(송승환)
Lee, Ju Han(이주한)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151806
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