Despite the increased sensitivity of current antibody detection methods significant deficiencies remain and herein we present such a case. A 62-year-old man with end-stage renal failure secondary to glomerulonephritis commenced peritoneal dialysis in 2008 following the failure of his primary deceased donor renal transplant due to chronic allograft nephropathy. His relevant comorbidities click here included: ischaemic heart disease with coronary artery bypass grafts, peripheral vascular disease, a thrombosed arteriovenous fistula, dyslipidaemia and numerous skin cancers which
had been treated and cured. In June 2011 he received an offer of a T-cell CDC crossmatch-negative deceased donor renal transplant. The donor was mismatched at three of six HLA loci and a DSAb to DR17 (mean fluorescence intensity
(MFI) 2073) was identified. Given that the patient was broadly sensitized to HLA antigens a better immunological match was thought unlikely to be received timeously and the transplant offer was accepted. However, just prior to transplantation a B-cell CDC crossmatch was performed. Using current serum it was weakly positive (2/8) as was the negative control, suggesting a problem with B-cell viability. The B-cell CDC crossmatch was therefore interpreted as negative; however, it was strongly positive with peak serum (8/8). The transplant physician then received a phone call from an experienced tissue typing scientist buy Dorsomorphin to discuss a further potential immunological issue. The patient was known to have an antibody to DR11 as a result of his previous transplant and in addition a DQA1*05 antibody. DR11 and DR3 (composed of the HLA DR17 and DR18 split antigen serotypes) are associated with similar DQA antigens, specifically DQA1*05, Vasopressin Receptor and the current donor was DR3 (DR17). Because information on donor DQA typing is not routinely available at the time of transplantation any known DQA antibodies can only be inferred as potentially donor-specific based on likely DQA status, predicted by common DR/DQ linkage disequilibrium data. In this case
our recipient had a DQA1*05 potential DSAb with an MFI >10 000. In addition, he was known to have several anti-DP antibodies and as for DQA DP typing of deceased donors is not routinely performed prospectively in Victoria. To further add to the complexity, donor DP antigens cannot be predicted based on linkage disequilibrium data. Following detailed explanations, defining the heightened risk of rejection associated with this transplant the patient elected to proceed with the support of his treating nephrologist. Immunosuppression was commenced with Methylprednisolone, Tacrolimus, Mycophenolate Mofetil and Basiliximab. Alternate day plasma exchange was initiated on the first postoperative day.