Ultra‐Late Antibody‐Mediated Rejection 30 Years After a Living‐Related Renal Allograft

Abstract

Antibody-mediated renal allograft rejection has become increasingly recognized and more clearly defined through the use of flow cytometry cross-matching and the deposition of C4d in renal allograft biopsies. All of the cases reported thus far have developed an antibody within 10 years of transplantation, and many lacked HLA and/or donor specificity.The present patient developed an anti-HLA donorspecific antibody between the 22nd and 30th year after a living-related renal transplant. At the 30th year posttransplantation, she experienced a rise in the serum creatinine from 0.7 to 1.9 mg/dL associated with transplant biopsy C4d deposition in peritubular capillaries and glomeruli. After the replacement of azathioprine with mycophenolate mofetil, and six apheresis treatments followed by two infusions of IVIG, the renal function stabilized at 1.9 mg/dL, 33 years after transplantation. Antibody-mediated rejection must be considered as a possible cause or renal allograft dysfunction at all time periods after transplantation.

Extremely High Association Between Appearance of HLA Antibodies and Failure of Kidney Grafts in a Five-Year Longitudinal Study

“…HLA antibodies have even been detected as much as 30 years after transplantation, resulting in compromise of renal function (13). Similar association of posttransplant antibodies with rejection of heart and lung transplants have been extensively summarized by Reinsmoen et al (14).…”

Antibodies against HLA-DQ α-chain and their role in organ transplantation

“…Already 25 years ago, Tosi et al demonstrated the presence of antibodies binding to the ␣-subunit of what were then called DC antigens (now known as DQ [3]). Weinstein et al [4] reported on a patient developing donor-specific antibodies (DSA) 30 years post-transplantation specific to HLA-A11. Upon further investigation it was found that additional DSA were generated against the donor QDA1*0501 chain.…”

Poor graft outcome in recipients withde novodonor-specific anti-HLA antibodies after living related kidney transplantation

“…Accordingly, the risk of humoral rejection exists at any time after RTx. In a recent study, one patient developed an anti‐HLA donor‐specific Ab between the 22nd and 30th year after LRKT and experienced AMR [26]. Therefore, we consider that long‐term monitoring for anti‐HLA Abs is necessary.…”