| Literature DB >> 24755353 |
Beata Mierzejewska1, Paul M Schroder2, Caitlin E Baum2, Annette Blair3, Connie Smith3, Rene J Duquesnoy4, Marilyn Marrari4, Amira Gohara3, Deepak Malhotra5, Dinkar Kaw5, Robert Liwski6, Michael A Rees1, Stanislaw Stepkowski7.
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.Entities:
Keywords: Antibody-mediated rejection; Donor-specific antibodies; Epitopes; Flow cytometry crossmatch; Kidney transplantation
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Year: 2014 PMID： 24755353 PMCID： PMC4119846 DOI： 10.1016/j.humimm.2014.04.001
Source DB: PubMed Journal: Hum Immunol ISSN： 0198-8859 Impact factor: 2.850