Early acute antibody-mediated rejection of a negative flow crossmatch 3rd kidney transplant with exclusive disparity at HLA-DP.


Journal Article

Donor-specific alloantibodies (DSA) to HLA-DP may cause antibody-mediated rejection (AMR), especially in re-transplants. We describe the immunization history of a patient who received 3 kidney transplants; the 3rd kidney was completely matched except at DPA1 and DPB1. Prior to the 3rd transplant, single antigen bead analysis (SAB) showed DSA reactivity against DPA1 shared by the 1st and 3rd donors, but B and T flow crossmatch (FXM) results were negative. Within 11 days the 3rd transplant underwent acute C4d+ AMR which coincided with the presence of complement (C1q)-binding IgG1 DSA against donor DPA1 and DPB1. Using HLAMatchmaker and SAB, we provide evidence that eplet (epitope) spreading on DPA1 and eplet sharing on differing DPB1 alleles of the 1st and 3rd transplants was associated with AMR. Since weak DSA to DPA1/DPB1 may induce acute AMR with negative FXM, donor DPA1/DPB1 high resolution typing should be considered in sensitized patients with DP-directed DSA.

Full Text

Duke Authors

Cited Authors

  • Mierzejewska, B; Schroder, PM; Baum, CE; Blair, A; Smith, C; Duquesnoy, RJ; Marrari, M; Gohara, A; Malhotra, D; Kaw, D; Liwski, R; Rees, MA; Stepkowski, S

Published Date

  • August 2014

Published In

Volume / Issue

  • 75 / 8

Start / End Page

  • 703 - 708

PubMed ID

  • 24755353

Pubmed Central ID

  • 24755353

Electronic International Standard Serial Number (EISSN)

  • 1879-1166

International Standard Serial Number (ISSN)

  • 0198-8859

Digital Object Identifier (DOI)

  • 10.1016/j.humimm.2014.04.001


  • eng