Acute antibody-mediated renal allograft rejection associated with HLA-Cw17 antibody

Manish Suneja; Sarat Kuppachi

doi:10.1093/ckj/sfs042

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Acute antibody-mediated renal allograft rejection associated with HLA-Cw17 antibody

Journal article

Open access

Peer reviewed

Acute antibody-mediated renal allograft rejection associated with HLA-Cw17 antibody

Manish Suneja and Sarat Kuppachi

Clinical kidney journal, Vol.5(3), pp.254-256

06/2012

DOI: 10.1093/ckj/sfs042

PMCID: PMC4400515

PMID: 26069779

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Abstract

Detection of donor-specific human leukocyte antigen (HLA) antibodies is an important part of diagnosis of antibody-mediated rejection (AMR) in the renal transplant population. Donor-specific antibodies (DSA) against HLA-C, a Class 1 major histocompatibility gene product, are not considered to be of major importance in renal transplant rejection. Typing for HLA-C is not a routine part of pre- and post-transplant evaluation. In roughly 10% of biopsy-proven C4d-positive rejections, DSA are not detected by standard testing protocols. In some of these cases, minor HLA and non-HLA antibodies have been implicated. The role of HLA-C antibodies in this patient group is not clear. We present a patient with acute renal graft dysfunction 21 months post-transplant. The allograft biopsy showed features of AMR with diffuse margination of inflammatory cells and diffuse C4d staining in peritubular capillaries. HLA-Cw17 antibody was detected by single-bead antigen Luminex assay, which was further confirmed by a mock flow crossmatch. This case highlights the importance of checking anti-HLA-Cw antibodies in patients with AMR and no detectable DSA using standard methods.

kidney transplant

HLA-Cw17

single-antigen bead assay

antibody-mediated rejection

crossmatch

Details

Title: Subtitle: Acute antibody-mediated renal allograft rejection associated with HLA-Cw17 antibody
Creators: Manish Suneja - Department of Internal Medicine, Division of Nephrology and Hypertension, University of Iowa Hospital and Clinics, IA, USA
Sarat Kuppachi - Department of Internal Medicine, Division of Nephrology and Hypertension, University of Iowa Hospital and Clinics, IA, USA
Resource Type: Journal article
Publication Details: Clinical kidney journal, Vol.5(3), pp.254-256
DOI: 10.1093/ckj/sfs042
PMID: 26069779
PMCID: PMC4400515
NLM abbreviation: Clin Kidney J
ISSN: 2048-8505
eISSN: 2048-8513
Language: English
Date published: 06/2012
Academic Unit: Stead Family Department of Pediatrics; Nephrology; Internal Medicine
Record Identifier: 9984093352402771

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