A SUCCESSFUL CHILD-TO-MOTHER RENAL TRANSPLANT IN A RECIPIENT WITH A PREOPERATIVE TNEG/BWPOS FLOW CROSSMATCH AND DONOR-DIRECTED ANTI-MHC CLASS II ALLOANTIBODIES.

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A SUCCESSFUL CHILD-TO-MOTHER RENAL TRANSPLANT IN A RECIPIENT WITH A PREOPERATIVE TNEG/BWPOS FLOW CROSSMATCH AND DONOR-DIRECTED ANTI-MHC CLASS II ALLOANTIBODIES.
Barbara J. Masten, Ph.D. , Margaret W. Chambers, B.A. , Cheri A. Blacksten, B.S. , Laura J. Gutierrez, B.A. , Cecily Yee and Thomas M. Williams, M.D. . Albuquerque NM, USA, TriCore References Labs and University of New Mexico, 87131, Pathology .

The clinical relevance of a Tneg/Bpos flow crossmatch with donor-directed anti-MHC class II alloantibodies is an issue of debate. Some reports show a significant association between early renal graft loss and the presence of donor-directed anti-MHC class II alloantibodies. Other reports suggest no deleterious effects. We evaluated the risk of transplanting across a Tneg/Bwpos flow crossmatch in a high-risk (child-to-mother) renal transplant patient with donor-directed anti-class II alloantibodies. The recipient, typed homozygous DRB1*04, had sensitization from six pregnancies, a peak MHC class II flow PRA of 77% and demonstrated anti-DR13, -14, -17, and -18 alloantibodies by FlowPRA Specific HLA class II beads. The recipient’s daughter was screened as a potential donor and a Tneg/Bwpos flow crossmatch was observed. The daughter was typed DRB1*04,*13, which seemed to explain the Bwpos crossmatch result. Two of the recipient’s sons were screened as potential donors. Both sons showed unexpected Tneg/Bneg crossmatch results given that they typed as DRB1*04,17 and DRB1*04,*13, respectively. Considering the desire of the DRB1*04,*13 daughter to be a donor and the Tneg/Bneg crossmatch with the DRB1*04,*13 son, the recipient was transplanted with a kidney from the daughter and immunosuppressed. A post-transplant cellular rejection (< 1 month) with tubulitis was treated with steroids. At ten months post-transplant, the recipient was doing well with a creatinine of 1.3. At >1 year post-transplant, the recipient is still doing well. In conclusion, for this case study, donor-directed anti-MHC class II antibody did not acutely impact allograft function.