Kidney transplantation in a recipient with anti-HLA antibody IgM positive

Abstract In general, anti-HLA antibody belongs to the IgG subclass, but there are very few reports of detection of anti-HLA IgM antibodies. In the present study, we report a renal transplant recipient with a positive NIH-complement dependent cytotoxicity (NIH-CDC) test. The patient was a 24-year-old...

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Bibliographic Details
Published in:Transplant immunology 2009-07, Vol.21 (3), p.150-154
Main Authors: Suzuki, Mari, Ishida, Hideki, Komatsu, Tomonori, Kennoki, Takafumi, Ishizuka, Tsutomu, Tanabe, Kazunari
Format: Article
Language:English
Subjects:
Adult
Allergy and Immunology
Anti-HLA antibody IgM
Female
Glomerulosclerosis, Focal Segmental - immunology
Glomerulosclerosis, Focal Segmental - pathology
Glomerulosclerosis, Focal Segmental - surgery
Glucocorticoids - therapeutic use
Graft Rejection - immunology
Histocompatibility Testing
HLA-A Antigens - immunology
HLA-A Antigens - metabolism
HLA-A24 Antigen
Humans
Immunoglobulin M - blood
Immunosuppressive Agents - therapeutic use
Kidney - immunology
Kidney - pathology
Kidney - surgery
Kidney transplantation
Kidney Transplantation - immunology
Living Donors
Male
Methylprednisolone - therapeutic use
Mycophenolic Acid - analogs & derivatives
Mycophenolic Acid - therapeutic use
Tacrolimus - therapeutic use
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Summary:Abstract In general, anti-HLA antibody belongs to the IgG subclass, but there are very few reports of detection of anti-HLA IgM antibodies. In the present study, we report a renal transplant recipient with a positive NIH-complement dependent cytotoxicity (NIH-CDC) test. The patient was a 24-year-old male with focal segmental glomerulosclerosis (FSGS) as the underlying kidney disease. He had been on maintenance hemodialysis since December 2003 and finally received a living-donor allograft from his mother in October 2008. Pre-transplantation, the NIH-CDC test was positive for both B and T cells, but the flow-cytometric crossmatch test (FCXM) was negative for both cells. The result of the panel-reactive antibody assay (PRA)-single beads test using anti-IgM antibody as the second antibody demonstrated that the positive NIH-CDC test was due to the presence of anti-HLA IgM antibody against the donor-specific antigen A24. Biopsy specimens showed thrombus formation in a small number of glomeruli immediately after the transplantation, but this finding was no longer seen at three months postoperatively. We report successful renal transplantation in a case with anti-HLA IgM antibody.
ISSN:0966-3274
1878-5492
DOI:10.1016/j.trim.2009.03.005