A case of early graft loss due to hyperacute rejection after ABO‐incompatible renal transplantation

• Published in: Clinical transplantation Vol. 22; no. s19; pp. 42 - 46
• Main Authors: Horie, Katsunori, Kanou, Yasuko, Sato, Motoyoshi, Tsuyuki, Mikito, Ishida, Shohei, Shimoji, Takeo, Fujita, Takashi, Kimura, Toru, Kato, Masashi, Tsuji, Yoshikazu, Kinukawa, Tsuneo
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2008; Blackwell
• Subjects: ABO; Biological and medical sciences; Fundamental and applied biological sciences. Psychology; Fundamental immunology; hyperacute rejection; incompatible renal transplantation; Medical sciences; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Incompatibility; ABO(H)-System; Loss; Homotransplantation; hyperacute rejection; Kidney; ABO; Case study; Medicine; Rejection; Blood group; Treatment; Urinary system; Surgery; Graft; Early; incompatible renal transplantation; Hyperacute; Kidney transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2008.00847.x

:  Graft survival rates of ABO‐incompatible (ABO‐I) living‐related kidney transplantations have greatly improved with the progress of immunosuppressive protocols. However, there are several case reports in which hyperacute rejections (HAR) or delayed hyperacute rejections (DHAR) occurred with immunosuppression, and acute humoral rejection is a risk factor for early graft loss in ABO‐I kidney transplantations. We report a case of early graft loss after ABO‐I kidney transplantation. A 51‐yr‐old male received an ABO‐I kidney transplant from his wife. Graft function deteriorated immediately after surgery and HAR developed. Although plasma exchange and steroid pulse were performed, graft function did not recover. A renal biopsy on postoperative day (POD) 4 indicated compatible findings with HAR. Renal function was deemed irreversible and the renal graft was removed on POD 7. A biopsy performed one h after transplantation revealed a clot in the glomerulus. As this was a case of ABO‐I transplantation without human leukocyte antigen class I and II antibodies in the pre‐ and postoperative flow panel reactive antibody, HAR was most likely caused by the presence of anti‐blood group antibodies. The preoperative anti‐A antibody value of ×64 was rather high in the present case. There is no clear standard for preoperative antibody values and it is difficult to predict prognosis preoperatively with the recent use of strong immunosuppressives. Although the mechanism of onset is unclear in this case, it is believed that the antibody titer should be reduced as much as possible prior to transplantation.