Hyperacute Rejection of Living Related Kidney Grafts Caused by Endothelial Cell–Specific Antibodies: Case Reports

De novo development of circulating anti-endothelial cell antibodies rather than pre-existing antibodies is associated with post-transplant allograft rejection

“…3,4 It has been suggested that antiendothelial cell antibodies (AECAs) have an important clinical role in organ transplantation [5][6][7][8][9] and have been implicated as a cause of hyper-acute rejection leading to immediate graft loss. [10][11][12][13][14][15] Increasing evidence suggests a correlation with both acute and chronic rejection. 7,8,10 In the Banff (2001) working classification of renal allograft pathology, AECAs were proposed as one cause of antibodymediated rejection in addition to antibodies directed against donor HLA.…”

Immunologic Concepts in Kidney Transplantation

“…A CDC test with endothelial cells has recently been developed and employed. In reports of hyperacute rejection despite a negative CDC crossmatch test, investigation with the endothelial cell CDC crossmatch test has revealed the presence of antibodies against donor endothelial cells [19]. While it is possible that non-HLA antibodies can cause a hyperacute rejection, this is likely a rare event.…”

Characteristics, Detection, and Clinical Relevance of Alloantibodies in Kidney Transplantation

“…Essentially, greater PRA values indicate greater numbers of anti-HLA antibodies in the patient, indicating a lower probability of receiving a kidney transplant. Indeed, donor-specific antibodies (DSAs) undeniably participate in hyperacute rejection (HAR), humoral acute rejection [also called accelerated antibody-mediated rejection (AMR)], and chronic rejection (CR) (Claas & Doxiadis, 2009;Gebel et al, 2003;Georgescu et al, 2007;Grandtnerova et al, 2008;Kerman et al, 1997;Lefaucheur et al, 2009;Poli et al, 2009;Scornik et al, 1989Scornik et al, , 1992Supon et al, 2001;Takemoto, 1995;Terasaki & Cai, 2008;Vasilescu et al, 2004;Ferry et al, 1997;Martin et al, 2003). HAR is frequently caused by preexisting DSAs that are directed at mismatched HLAs or by high concentrations of isohemagglutinins against major blood group antigens.…”

“…Recipients of perfectly matched kidney transplants generally survive longer and do not frequently develop rejection; however, 2-5% of zero HLA-mismatched kidney recipients lose their grafts due to HAR or AMR (Rodriguez et al, 2000). These graft failures can be caused by HLA allele-specific antibodies and/or non-HLA antibodies (Ferry et al, 1997;Grandtnerova et al, 2008;Lomago et al, 2010;Lucchiari et al, 2000;Perrey et al, 1998;Sumitran-Karuppan et al, 1997). In 1976, Moraes and Stastny described eight groups of non-HLA antigens that are expressed on monocytes and EC (Moraes & Stastny, 1976).…”