SIMULTANEOUS IGG/IGM DONOR-SPECIFIC DQA ALLOANTIBODY PRODUCTION: CASE STUDY

摘要

The subject in this case is a 24-year-old male who was diagnosed with cardiomyopathy of unknown origin and received a heart transplant May 2007. At the time of transplant he was not sensitized against HLA Class I and II. The donor was mismatched for A24, B44, B55, Cw05, Cw09, DR12, DR52 and DQ07. In October 2009, he presented with declining cardiac function, and was referred for post-transplant donor-specific antibody (DSA) testing. The initial testing consisted of IgG single-antigen Luminex (One Lambda LSA). The assay revealed IgG reactivity against several Class II single-antigen beads (SAB), with a pattern that strongly suggested specificity for DQA05/06, and weaker reactivity against DQB03. The typical DQA linked to the DR12/DQB07 haplotype is DQA05, and subsequent typing of the donor confirmed the presence of DQA*0505. Therefore the bead representing DQB07/DQA0505 was utilized to report MFI values. The MFI for this bead was 8200, and was reported to the attending cardiologist. At this time, the biopsy data was available, and the cardiologist confirmed the presence of C4d staining in the graft, along with IgG and IgM deposition. Rejection therapy