Plasma cell‐rich acute cellular rejection of a transplanted kidney associated with antibody to the red cell Kidd antigen

Abstract

Plasma cell-rich acute cellular rejection of a transplanted kidney is described in association with the identification of serum antibody to the red cell Kidd antigen, Jk-b, which is also found in the kidney. This antibody was formed without a history of a recent blood transfusion or exposure to intravenous immunoglobulin. The role this antibody could have in the rejection of the transplant is discussed.

A case of plasma cell‐rich acute rejection 18 months after kidney transplantation successfully treated with steroid pulse therapy

“…The PCAR cases reported by David‐Neto et al did not respond to steroid therapy (4). Hamilton et al reported a case of PCAR treated with a steroid, thymoglobulin, and RIT followed by plasmapheresis (PP) and intravenous immune globulin (IVIG) therapy in which the patient lost the allograft (5). Adrogue et al described four episodes of PCAR in two patients who were treated with IVIG (6).…”

“…Recently there have been several reports of plasma cell-rich acute rejection (PCAR), which are characterized by mature plasma cells comprising more than 10-20% of the inflammatory cells infiltrating to the renal allograft (1)(2)(3)(4)(5)(6)(7)(8). Most of the reports have suggested that PCAR is associated with graft loss or severe impairment of renal function and that the function of almost none of the grafts returned to baseline (1)(2)(3)(4)(5)(6)(7)(8). We report a case of PCAR, which was successfully treated with steroid pulse therapy alone.…”

Kidd blood group system: outwardly simple with hidden complexity

“…Reports suggest a role for JK antibodies in histocompatibility and renal graft survival. Five published cases describe renal graft rejection at the time of concurrent anti‐Jk a or anti‐Jk b detection . The rejection episodes occurred up to 9 years posttransplant and, in at least 3 cases, were associated with non‐compliance with the patient's immunosuppressive therapy.…”

Additional case of acute cellular kidney rejection associated with the presence of antibodies to the red blood cell Kidd antigen

“…Earlier we reported a case of plasma cell‐rich acute cellular rejection of a transplanted kidney, which was associated with a serum antibody to the red blood cell (RBC) Kidd antigen, Jk‐b, without a history of recent transfusion. We presented data to suggest that the plasma cells in the kidney made antibodies to the Jk‐b antigen, which is also present in the kidney and may, in turn, have contributed to the rejection process (1). Since that time, we have identified a second patient with a milder but similar clinical course and antibodies to Jk‐a, the polymorphic allele Kidd antigen.…”

“…We previously discussed the possible functional relationship between kidney rejection and antibodies to the RBC Kidd antigen (1). The protein carrying the Kidd antigen is the product of a single gene for a urea transporter on both RBCs and the endothelial cells of the vasa recta of the kidney (2).…”