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Successful kidney transplantation across a positive complement-dependent cytotoxicity crossmatch by using C1q assay-directed, bortezomib-assisted desensitization: A case report.

Authors
 Juhan Lee  ;  Borae G. Park  ;  Hyang Sook Jeong  ;  Youn Hee Park  ;  Sinyoung Kim  ;  Beom Seok Kim  ;  Hye Jin Kim  ;  Kyu Ha Huh  ;  yeon Joo Jeong  ;  Yu Seun Kim 
Citation
 Medicine, Vol.96(39) : e8145, 2017 
Journal Title
 Medicine 
ISSN
 0025-7974 
Issue Date
2017
MeSH
Desensitization, Immunologic/methods ; Graft Rejection*/immunology ; Graft Rejection*/prevention & control ; HLA-B Antigens/analysis ; Histocompatibility Antigens/analysis ; Histocompatibility Testing/methods ; Humans ; Kidney Failure, Chronic*/immunology ; Kidney Failure, Chronic*/surgery ; Kidney Transplantation*/adverse effects ; Kidney Transplantation*/methods ; Male ; Middle Aged ; Preoperative Care/methods ; Treatment Outcome
Abstract
RATIONALE: Human leukocyte antigen (HLA) is the major immunologic barrier in kidney transplantation (KT). Various desensitization protocols to overcome the HLA barrier have increased the opportunity for transplantation in sensitized patients. In addition, technological advances in solid-phase assays have permitted more comprehensive assessment of donor-specific antibodies. Although various desensitization therapies and immunologic techniques have been developed, the final transplantation decision is still based on the classic complement-dependent cytotoxicity (CDC) crossmatch (XM) technique. Some patients who fail to achieve negative XM have lost their transplant opportunities, even after receiving sufficient desensitization therapies. PATIENT CONCERNS: A 57-year-old male with end-stage renal disease secondary to chronic glomerulonephritis was scheduled to have a second transplant from his son, but CDC XM was positive. DIAGNOSES: Initial CDC XM (Initial T-AHG 1:32) and flow-cytometry XM were positive. Anti-HLA-B59 donor specific antibody was detected by Luminex single antigen assay. INTERVENTIONS: Herein, we report a successful case of KT across a positive CDC XM (T-AHG 1:8 at the time of transplantation) by using C1q assay-directed, bortezomib-assisted desensitization. After confirming a negative conversion in the C1q donor-specific antibody, we decided to perform KT accepting a positive AHG-CDC XM of 1:8 at the time of transplantation. OUTCOMES: The posttransplant course was uneventful and a protocol biopsy at 3 months showed no evidence of rejection. The patient had excellent graft function at 12 months posttransplant. LESSONS: The results of XM test and solid-phase assay should be interpreted in the context of the individual patient.
Files in This Item:
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DOI
10.1097/MD.0000000000008145
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
김범석(Kim, Beom Seok) ORCID logo https://orcid.org/0000-0002-5732-2583
김신영(Kim, Sin Young) ORCID logo https://orcid.org/0000-0002-2609-8945
김유선(Kim, Yu Seun) ORCID logo https://orcid.org/0000-0002-5105-1567
김혜진(Kim, Hye Jin)
박금보래(Park, Borae G)
박윤희(Park, Youn Hee) ORCID logo https://orcid.org/0000-0001-8458-1495
정향숙(Jeong, H.S.)
정현주(Jeong, Hyeon Joo) ORCID logo https://orcid.org/0000-0002-9695-1227
허규하(Huh, Kyu Ha) ORCID logo https://orcid.org/0000-0003-1364-6989
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160847
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