CHRONIC KIDNEY ALLOGRAFT REJECTION DUE TO PRE-TRANSPLANT SENSITIZATION TO HLA-DP

摘要

Aim: The Immunogenicity of HLA-DP is generally focused on a few shared epitopes of the DPB1 molecule including HLA-DPB1 epitopes 55-57DED and 84-87DEAV. We report the 5-year outcome of a kidney transplant recipient who was re-grafted across an incompatible crossmatch due to donor-directed anti-HLA-DP antibodies from a Deceased Donor (DD). The patient was matched at the allele level for HLA-A, B, Cw, DRB1, DRB3, and DQB1 specificities (1). Methods: A 41 y-old Caucasian female with a history of one pregnancy and multiple blood transfusions received her first DD kidney transplant in 1986 and a 2nd DD kidney transplant in 1996 (Table 1). She was diagnosed with post-transplant lymphoproliferative disorder (PTLD) in 1997 and her immunosupressive medication was discontinued. She developed antibodies to mismatched donor Class I and Class II antigens (PRA: 40-80%). In addition, anti-HLA DP antibodies were also detected with FlowPRA single antigen bead assay. In 2005, she received a 3rd kidney from a zero A, B, Cw, DR, and DQ mismatched DD kidney transplant.