Chinese Journal of Tissue Engineering Research ›› 2011, Vol. 15 ›› Issue (18): 3315-3318.doi: 10.3969/j.issn.1673-8225.2011.18.021

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Severe acute humoral rejection induced by secondary immune response at early stage after kidney transplantation

Chen Jian-rong, Li Liu-yang, Qian Jun, Zhao Ming, Liu Zhan-guo, Liu Yong-guang, Guo Ying, Liu Zhen-xi   

  1. Department of Organ Transplantation, Zhujiang Hospital, Southern Medical University, Guangzhou  510282, Guangdong Province, China
  • Received:2010-11-26 Revised:2011-02-20 Online:2011-04-30 Published:2011-04-30
  • Contact: Zhao Ming, Doctor, Professor, Doctoral supervisor, Department of Organ Transplantation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China zhaoming02@hotmail.com
  • About author:Chen Jian-rong★, Master, Associate chief technician, Department of Organ Transplantation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China liliuyang@medmail.com.cn
  • Supported by:

    Guangdong Natural Science Foundation, No. 06024438*

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Abstract:

BACKGROUND: The prevention of hyperacute or acute rejection in highly sensitized recipients after renal transplantation has obtained satisfactory results. However, there are rare reports about secondary immune response of sensitized recipients with negative panel reactive antibody (PRA) after kidney transplantation.
OBJECTIVE: To explore the mechanism of acute humoral rejection (AHR) in sensitized recipients with negative PRA for early prophylaxis.
METHODS: The AHR related factors including HLA IgG HE stain, anti-C4d deposition and cell surface molecules were analyzed in 21 PRA negative recipients receiving kidney for the first time from the 1st day to the 14th day post-Tx.
RESULTS AND CONCLUSION: All the 21 patients had records of blood transfusion or pregnancy. In 18 patients, anti-HLAⅠIgG and 11 pones anti-HLAⅡIgG positive rates were both over 80% on the 7th day. Five female ones were found rupture of allograft and both anti-HLAⅠand anti-HLAⅡIgG positive rates were over 96% during the 5th and 8th day. DSA(donor specific antibodies) were found in all the 21 patients, among of them, 13 patients including 5 ones with rupture of kidney had mismatching of HLA-A2 and HLA-A11. Kidney damage was shown by patho-histomorphology examination. Immunohistochemistry examination showed C4d deposition in peritubular capillary zone (PTC), In situ staining showed CD34(+),CD68(+)and CD4(+) positive. Pre-operative test of PRA can reflect the sensitization to some extent but not completely. Prediction and diagnosis of AHR would be done by early monitoring of PRA post-Tx. The diagnosis rate of AHR could be improved by the specific pathological markers of C4d and CD68 which were used as diagnostic criteria. HLA-A2 and HLA-A11 are genes highly dangerous for sensitized patients suffering from AHR.

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