Acute Humoral Rejection in a Zero Mismatch Deceased Donor Renal Transplant Due to an Antibody to an HLA-DP α

Frequency of HLA-DP-specific antibodies and a possible new cross-reacting group

“…Approximately half of the patients with any HLA-specific antibody also demonstrated reactivity with DP. This finding is clinically significant because HLA-DP antibody has been associated with rejection [7][8][9]. Notably, sera reactive with DP were more likely to occur in previously transplanted patients than in patients who had not been transplanted (62 vs 38%).…”

“…However, DP has been demonstrated to be constitutively expressed on normal renal microvascular endothelial cells, implicating its ability to be a target of rejection [6]. This has led to further studies documenting transplant failure and rejection caused by DP antibodies [7][8][9].…”

Luminex and antibody detection in kidney transplantation

“…The positive crossmatch was the result of a mismatch on the HLA-DPB locus. Several studies have shown that mainly anti-HLA-C and anti-HLA-DP donorspecific antibodies were found in patients displaying acute rejection [28][29][30]. Pretransplantation anti-HLA-DP antibodies seemed to be involved more frequently in poor graft outcome, as shown in several recently published cases.…”

“…However, the recent development of microspheres coated with HLA-DP, HLA-C, and HLA-DQA antigens has allowed exploration of the role of these antibodies in kidney transplantation [28][29][30]. Vaidya et al [31] reported the case of a patient in end-stage renal disease, who presented a positive crossmatch with B cells with a donor to 0 mismatch on loci HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1.…”

Pretransplant anti-HLA-Cw and anti-HLA-DP antibodies in sensitized patients

“…However, virtual cross-matching may be more successful if complete HLA-A, B, Cw, DR, DQ, and DP donor typing and antibodies to these antigens in recipients are available. HLA-Cw and DP antigens have been considered to be less immunogenic than other HLA antigens but recent case reports and case series documented acute and chronic rejection episodes in patients with isolated anti-HLA-Cw or DP antibodies [3][4][5][6][7][8][9][10][11]. Tambur et al analyzed 1586 flow-cytometry crossmatch results to compare virtual cross-match to actual crossmatch and reported that 40% of the cases with a positive actual flow-cytometry cross-match and negative virtual cross-match were due to anti-HLA-Cw antibodies [12].…”