2016 Volume 4 Issue 1 Pages 31-39
Pretransplant donor specific anti-HLA antibodies are significant obstacle in renal transplantation and a risk factor for antibody mediated rejection. In the last decade, short-term graft survival has been improved in HLA-incompatible renal transplantation because of the availability of pretransplant desensitization protocols including rituximab, plasma exchange and intravenous immunoglobulin, availability of better methods of detecting and characterizing anti-HLA antibodies, and better understanding of antibody-mediated rejection. Herein we report three HLA incompatible renal transplant recipients who had negative T-cell complement-dependent cytotoxicity cross-match and positive T-cell flow cytometry cross-match. Two recipients, in whom T-cell flow cytometry cross-match remained positive at the time of renal transplantation after plasma exchange and rituximab treatment, had no rejection and displayed good renal function. Renal allograft biopsies conducted at 1 year after transplantation demonstrated no evidence of rejection, peritubular capillaritis, and C4d deposition. In the other recipient, T-cell flow cytmetry cross-match tests remained positive despite splenectomy combined with plasma exchange before renal transplantation. She had antibody mediated rejection early after renal transplantation. Renal function was recovered after treatment with plasma exchange and steroid pulse, and T-cell flow cross-match became negative. However, de novo donor specific antibody appeared four years after renal transplantation. Renal allograft biopsies demonstrated C4d deposition in peritubular capillaries and transplant glomerulopathy.
