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NDT Advance Access published online on October 20, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp526
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Antibody-mediated rejection following transplantation from an HLA-identical sibling

Carrie A. Grafft1, Lynn D. Cornell2, James M. Gloor1,3, Fernando G. Cosio1,3, Manish J. Gandhi4, Patrick G. Dean3,5, Mark D. Stegall3,5 and Hatem Amer1,3

1 Division of Nephrology and Hypertension, Department of Internal Medicine 2 Division of Anatomic Pathology 3 William J von Liebig Transplant Center; Mayo Clinic 4 Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology 5 Division of Transplantation Surgery, Department of Surgery, Rochester, MN, USA

Correspondence and offprint requests to: Hatem Amer; E-mail: amer.hatem{at}mayo.edu



  Abstract

Putative antibody-mediated rejection (AMR) in HLA-identical sibling transplantation has rarely been reported and occurred before routine calcineurin inhibitor use. A 29-year-old male developed allograft dysfunction following an HLA-identical renal transplant from his sibling. A pretransplant panel-reactive antibody (PRA) was elevated, pre-transplant crossmatch was negative and no donor-specific antibody (DSA) was identified. Induction with alemtuzumab was followed by maintenance immunosuppression with corticosteroids, tacrolimus and mycophenolate. A biopsy for allograft dysfunction suggested AMR, but DSA could not be detected. Treatment for rejection was transiently successful. Undetectable minor histocompatibility antibodies may have contributed.

Keywords: acute allograft dysfunction; alemtuzumab; limitations of testing; living kidney donor; minor histocompatibility antigens

Received for publication: 31. 3.09
Accepted in revised form: 14. 9.09


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