1.7
#39
HYPERACUTE REJECTION OF A 0 HLA-MISMATCHED KIDNEY: A CASE STUDY.
Brian M. Susskind, PhD , Gregg Boothe MS , Kathleen Larimore MT , Peter Stastny MD and E. Steve Woodle MD . Cincinnati OH, Hoxworth Blood Center, 45267, Transplantation Immunology Division ; Cincinnati OH, Hoxworth Blood Center, 45267, Donor Testing and Reference Lab ; Dallas TX, University of Texas Southwestern Medical Center, 75235, Transplant Immunology Laboratory and Cincinnati OH, University of Cincinnati College of Medicine, 45267, Department of Surgery .

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A lupus nephritis patient had previously lost a 4 ABDR-matched LRD kidney to accelerated acute rejection, despite a history of 0% CDC PRA. At the time of transplant #2, a 0 ABDR-mismatched cadaveric kidney, CDC PRA was 62% (IgG). Cytotoxic and flow cytometry crossmatches (XM) were negative; cold ischemia time was 20 hours. While the patient was still open, however the kidney becamee edematous and blue. Histopathology was consistent with hyperacute rejection (tubule necrosis, focal acute inflammation, congested glomeruli, fibrin thrombi). Repeat FCXMs were negative, even after pronase treatment. Undetected HLA mismatches were ruled out by allelic HLA typing for A,B,C,DR,DQ. ABO-incompatibility was ruled out: patient and donor were A1 subtype; patient was negative for antibodies to 20 other blood group antigens (e.g., anti-Lewis, Lutheran, Kell, Duffy). Sample mix-up was ruled out by HLA typing the nephrectomized donor kidney. Pre- and posttransplant sera were negative for antibodies against cardiolipin, phosphatidylserine, phosphatidylethanolamine, and phosphatidylcholine, as well as anti-platelet specific antigens.. Anti-endothelial cell antibody analyses by ELISA with recombinant MICA*001, MICA*002, MICA*004, MICA*008 and MICA*009, were likewise negative; recipient and donor both appear to be MICA*008 homozygous. In summary, this lupus nephritis patient developed accelerated acute rejection following a 4 ABDR LRD primary transplant despite a history of 0% CDC PRA, and a repeat renal transplant from a 0 ABDR-mismatched cadaveric donor was lost due to hyperacute rejection despite negative flow cytometry crossmatches. No reasons for recurrent early graft rejection were forthcoming; studies are still in progress to identify the cause.