Probable C4d‐negative accelerated acute antibody‐mediated rejection due to non‐HLA antibodies

Abstract

We report a case of probable C4d-negative accelerated acute antibody-mediated rejection due to non-HLA antibodies. A 44 year-old male was admitted to our hospital for a kidney transplant. The donor, his wife, was an ABO minor mismatch (blood type O to A) and had Gitelman syndrome. Graft function was delayed; his serum creatinine level was 10.1 mg/dL at 3 days after transplantation. Open biopsy was performed immediately; no venous thrombosis was observed during surgery. Histology revealed moderate peritubular capillaritis and mild glomerulitis without C4d immunoreactivity. Flow cytometric crossmatching was positive, but no panel-reactive antibodies against HLA or donor-specific antibodies (DSAbs) to major histocompatibility complex class I-related chain A (MICA) were detected. Taken together, we diagnosed him with probable C4d-negative accelerated antibody-mediated rejection due to non-HLA, non-MICA antibodies, the patient was treated with steroid pulse therapy (methylprednisolone 500 mg/day for 3 days), plasma exchange, intravenous immunoglobulin (40 g/body), and rituximab (200 mg/body) were performed. Biopsy at 58 days after transplantation, at which time S-Cr levels were 1.56 mg/dL, found no evidence of rejection. This case, presented with a review of relevant literature, demonstrates that probable C4d-negative accelerated acute AMR can result from non-HLA antibodies.

B Cell Activating Factor, Renal Allograft Antibody-Mediated Rejection, and Long-Term Outcome

“…Standardized scoring of C4d (the complement split product) staining in renal graft biopsies was set at the Banff meeting of 2003 [ 6 ]. However, multiple studies that followed strongly supported the existence of ABMR with negatively or minimal/equivocal C4d deposition within peritubular capillaries [ 7 – 9 ].…”

Long-term Clinical Course after Living Kidney Donation by a Patient with Gitelman Syndrome Harboring a Compound Heterozygous Mutation of the <i>SLC12A3</i> Gene

“…We herein report the clinical course of a 44-year-old woman who was diagnosed with GS by a genetic analysis during a preoperative donor evaluation for kidney transplantation. We previously reported the clinical course of the recipient who received her kidney ( 12 ).…”

Biomarkers in Solid Organ Transplantation

“…These antibodies are clinically associated with a higher risk for hyperacute rejection, short-term graft survival, and antibody-mediated rejection. [32][33][34][35][36][37][38] Since the report of antiendothelial cell antibodies, 32 multiple important non-HLA antibodies have been identified. Major histocompatibility class 1-related chain A antigens that share the major histocompatibility locus have been well-described as being related to an increased risk for kidney allograft failure.…”