Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP

Beata Mierzejewska; Paul M. Schroder; Caitlin E. Baum; Annette Blair; Connie Smith; Rene J. Duquesnoy; Marilyn Marrari; Amira Gohara; Deepak Malhotra; Dinkar Kaw; Robert Liwski; Michael A. Rees; Stanislaw Stepkowski

doi:10.1016/j.humimm.2014.04.001

Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP

Beata Mierzejewska, Paul M. Schroder, Caitlin E. Baum, Annette Blair, Connie Smith, Rene J. Duquesnoy, Marilyn Marrari, Amira Gohara, Deepak Malhotra, Dinkar Kaw, Robert Liwski, Michael A. Rees, Stanislaw Stepkowski

Medicine

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

Abstract

Donor-specific alloantibodies (DSA) to HLA-DP may cause antibody-mediated rejection (AMR), especially in re-transplants. We describe the immunization history of a patient who received 3 kidney transplants; the 3rd kidney was completely matched except at DPA1 and DPB1. Prior to the 3rd transplant, single antigen bead analysis (SAB) showed DSA reactivity against DPA1 shared by the 1st and 3rd donors, but B and T flow crossmatch (FXM) results were negative. Within 11. days the 3rd transplant underwent acute C4d+ AMR which coincided with the presence of complement (C1q)-binding IgG1 DSA against donor DPA1 and DPB1. Using HLAMatchmaker and SAB, we provide evidence that eplet (epitope) spreading on DPA1 and eplet sharing on differing DPB1 alleles of the 1st and 3rd transplants was associated with AMR. Since weak DSA to DPA1/DPB1 may induce acute AMR with negative FXM, donor DPA1/DPB1 high resolution typing should be considered in sensitized patients with DP-directed DSA.

Original language	English
Pages (from-to)	703-708
Number of pages	6
Journal	Human Immunology
Volume	75
Issue number	8
DOIs	https://doi.org/10.1016/j.humimm.2014.04.001
Publication status	Published - Aug 2014

Bibliographical note

Funding Information:
Funding support for this study was provided by the NIH : R01-A1-090244-01.

ASJC Scopus Subject Areas

Immunology and Allergy
Immunology

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10.1016/j.humimm.2014.04.001

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Mierzejewska, B., Schroder, P. M., Baum, C. E., Blair, A., Smith, C., Duquesnoy, R. J., Marrari, M., Gohara, A., Malhotra, D., Kaw, D., Liwski, R., Rees, M. A., & Stepkowski, S. (2014). Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP. Human Immunology, 75(8), 703-708. https://doi.org/10.1016/j.humimm.2014.04.001

Mierzejewska, B, Schroder, PM, Baum, CE, Blair, A, Smith, C, Duquesnoy, RJ, Marrari, M, Gohara, A, Malhotra, D, Kaw, D, Liwski, R, Rees, MA & Stepkowski, S 2014, 'Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP', Human Immunology, vol. 75, no. 8, pp. 703-708. https://doi.org/10.1016/j.humimm.2014.04.001

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title = "Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP",

abstract = "Donor-specific alloantibodies (DSA) to HLA-DP may cause antibody-mediated rejection (AMR), especially in re-transplants. We describe the immunization history of a patient who received 3 kidney transplants; the 3rd kidney was completely matched except at DPA1 and DPB1. Prior to the 3rd transplant, single antigen bead analysis (SAB) showed DSA reactivity against DPA1 shared by the 1st and 3rd donors, but B and T flow crossmatch (FXM) results were negative. Within 11. days the 3rd transplant underwent acute C4d+ AMR which coincided with the presence of complement (C1q)-binding IgG1 DSA against donor DPA1 and DPB1. Using HLAMatchmaker and SAB, we provide evidence that eplet (epitope) spreading on DPA1 and eplet sharing on differing DPB1 alleles of the 1st and 3rd transplants was associated with AMR. Since weak DSA to DPA1/DPB1 may induce acute AMR with negative FXM, donor DPA1/DPB1 high resolution typing should be considered in sensitized patients with DP-directed DSA.",

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AU - Smith, Connie

AU - Duquesnoy, Rene J.

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AU - Malhotra, Deepak

AU - Kaw, Dinkar

AU - Liwski, Robert

AU - Rees, Michael A.

AU - Stepkowski, Stanislaw

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AB - Donor-specific alloantibodies (DSA) to HLA-DP may cause antibody-mediated rejection (AMR), especially in re-transplants. We describe the immunization history of a patient who received 3 kidney transplants; the 3rd kidney was completely matched except at DPA1 and DPB1. Prior to the 3rd transplant, single antigen bead analysis (SAB) showed DSA reactivity against DPA1 shared by the 1st and 3rd donors, but B and T flow crossmatch (FXM) results were negative. Within 11. days the 3rd transplant underwent acute C4d+ AMR which coincided with the presence of complement (C1q)-binding IgG1 DSA against donor DPA1 and DPB1. Using HLAMatchmaker and SAB, we provide evidence that eplet (epitope) spreading on DPA1 and eplet sharing on differing DPB1 alleles of the 1st and 3rd transplants was associated with AMR. Since weak DSA to DPA1/DPB1 may induce acute AMR with negative FXM, donor DPA1/DPB1 high resolution typing should be considered in sensitized patients with DP-directed DSA.

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Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP

Abstract

Bibliographical note

ASJC Scopus Subject Areas

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