Clinical course and pathologic findings of successful second ABO-incompatible renal transplantation in a patient with donor-specific anti-HLA antibody

Abstract:  Donor-specific anti-HLA antibody and anti-blood group antibody could cause antibody-mediated rejection (AMR). Here, we report a successful second ABO-incompatible (ABO-I) renal transplantation in a patient with donor-specific anti-HLA antibody and its pathologic findings. A 50-yr-old woman underwent second ABO-I (A1 to O) renal transplantation. She had received the first renal graft from her mother following splenectomy in July 2003; however, graft function was lost 50 d after transplantation because of AMR. The patient received the second renal graft in November 2005, from her husband whose blood type was also A1. The recipient had donor-specific anti-HLA antibody because flow panel reactive antibody and flow cytometry crossmatch were strongly positive prior to the plasmapheresis (PP) therapy. Pre-transplant intensive immunosuppression, PP, and low dose (100 mg/m²) anti-CD20 antibody (rituximab) administration were performed as desensitization therapy. The recipient clinically developed acute rejection, and allograft biopsy specimen at day 6 post-transplant revealed AMR type II according to the Banff 2003 classification. However, the graft function was rescued by PP/low dose (100 mg/kg) intravenous immunoglobulin (IVIG) therapy, and the biopsy specimen at day 43 post-transplant showed border-line change without AMR. Rituximab and PP/low-dose IVIG therapy might improve the clinical course and pathologic findings in this AMR-related high-risk transplantation.