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Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis
BACKGROUND: The major challenge in ABO-incompatible transplantation is to minimize antibody-mediated rejection. Effective reduction of the anti-ABO blood group antibodies at the time of transplantation has made ABO-incompatible kidney transplantation a growing practice in our hospital and in centers...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925416/ https://www.ncbi.nlm.nih.gov/pubmed/24517251 http://dx.doi.org/10.1186/1471-2369-15-31 |
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author | de Weerd, Annelies Vonk, Alieke van der Hoek, Hans van Groningen, Marian Weimar, Willem Betjes, Michiel van Agteren, Madelon |
author_facet | de Weerd, Annelies Vonk, Alieke van der Hoek, Hans van Groningen, Marian Weimar, Willem Betjes, Michiel van Agteren, Madelon |
author_sort | de Weerd, Annelies |
collection | PubMed |
description | BACKGROUND: The major challenge in ABO-incompatible transplantation is to minimize antibody-mediated rejection. Effective reduction of the anti-ABO blood group antibodies at the time of transplantation has made ABO-incompatible kidney transplantation a growing practice in our hospital and in centers worldwide. ABO antibodies result from contact with A- and B-like antigens in the intestines via nutrients and bacteria. We demonstrate a patient with fulminant antibody-mediated rejection late after ABO-incompatible kidney transplantation, whose anti-A antibody titers rose dramatically following Serratia marcescens sepsis. CASE PRESENTATION: A 58-year-old woman underwent an ABO-incompatible kidney transplantation for end-stage renal disease secondary to autosomal dominant polycystic kidney disease. It concerned a blood group A1 to O donation. Pre-desensitization titers were 64 for anti-blood group A IgM and 32 for anti-blood group A IgG titers. Desensitization treatment consisted of rituximab, tacrolimus, mycophenolate mofetil, corticosteroids, immunoadsorption and intravenous immunoglobulines. She was readmitted to our hospital 11 weeks after transplantation for S. marcescens urosepsis. Her anti-A IgM titer rose to >5000 and she developed a fulminant antibody-mediated rejection. We hypothesized that the (overwhelming) presence in the blood of S. marcescens stimulated anti-A antibody formation, as S. marcescens might share epitopes with blood group A antigen. Unfortunately we could not demonstrate interaction between blood group A and S. marcescens in incubation experiments. CONCLUSION: Two features of this post-transplant course are remarkably different from other reports of acute rejection in ABO-incompatible kidney transplantation: first, the late occurrence 12 weeks after kidney transplantation and second, the very high anti-A IgM titers (>5000), suggesting recent boosting of anti-A antibody formation by S. marcescens. |
format | Online Article Text |
id | pubmed-3925416 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-39254162014-02-16 Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis de Weerd, Annelies Vonk, Alieke van der Hoek, Hans van Groningen, Marian Weimar, Willem Betjes, Michiel van Agteren, Madelon BMC Nephrol Case Report BACKGROUND: The major challenge in ABO-incompatible transplantation is to minimize antibody-mediated rejection. Effective reduction of the anti-ABO blood group antibodies at the time of transplantation has made ABO-incompatible kidney transplantation a growing practice in our hospital and in centers worldwide. ABO antibodies result from contact with A- and B-like antigens in the intestines via nutrients and bacteria. We demonstrate a patient with fulminant antibody-mediated rejection late after ABO-incompatible kidney transplantation, whose anti-A antibody titers rose dramatically following Serratia marcescens sepsis. CASE PRESENTATION: A 58-year-old woman underwent an ABO-incompatible kidney transplantation for end-stage renal disease secondary to autosomal dominant polycystic kidney disease. It concerned a blood group A1 to O donation. Pre-desensitization titers were 64 for anti-blood group A IgM and 32 for anti-blood group A IgG titers. Desensitization treatment consisted of rituximab, tacrolimus, mycophenolate mofetil, corticosteroids, immunoadsorption and intravenous immunoglobulines. She was readmitted to our hospital 11 weeks after transplantation for S. marcescens urosepsis. Her anti-A IgM titer rose to >5000 and she developed a fulminant antibody-mediated rejection. We hypothesized that the (overwhelming) presence in the blood of S. marcescens stimulated anti-A antibody formation, as S. marcescens might share epitopes with blood group A antigen. Unfortunately we could not demonstrate interaction between blood group A and S. marcescens in incubation experiments. CONCLUSION: Two features of this post-transplant course are remarkably different from other reports of acute rejection in ABO-incompatible kidney transplantation: first, the late occurrence 12 weeks after kidney transplantation and second, the very high anti-A IgM titers (>5000), suggesting recent boosting of anti-A antibody formation by S. marcescens. BioMed Central 2014-02-12 /pmc/articles/PMC3925416/ /pubmed/24517251 http://dx.doi.org/10.1186/1471-2369-15-31 Text en Copyright © 2014 de Weerd et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report de Weerd, Annelies Vonk, Alieke van der Hoek, Hans van Groningen, Marian Weimar, Willem Betjes, Michiel van Agteren, Madelon Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis |
title | Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis |
title_full | Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis |
title_fullStr | Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis |
title_full_unstemmed | Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis |
title_short | Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis |
title_sort | late antibody-mediated rejection after abo-incompatible kidney transplantation during gram-negative sepsis |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925416/ https://www.ncbi.nlm.nih.gov/pubmed/24517251 http://dx.doi.org/10.1186/1471-2369-15-31 |
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