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

Abstract

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.

Clinical Outcome of ABO-Incompatible Living Unrelated Donor Kidney Transplantation

“…ABOincompatible kidney transplantation has become an acceptable treatment option in Japan, accounting for more than 20% of all living donor kidney transplants. However, there have been several reports of hyperacute rejections or delayed hyperacute rejections, even with the use of current immunosuppressive regimens and adequate pretransplant removal of anti-A/B antibodies [2]. Meanwhile, more than 25% of all living donor kidney transplants in Japan utilize living unrelated donors.…”