PMID- 22425738
OWN - NLM
STAT- MEDLINE
DCOM- 20130118
LR  - 20220321
IS  - 1879-1166 (Electronic)
IS  - 0198-8859 (Linking)
VI  - 73
IP  - 5
DP  - 2012 May
TI  - Low median fluorescence intensity could be a nonsafety concept of immunologic 
      risk evaluation in patients with shared molecular eplets in kidney 
      transplantation.
PG  - 522-5
LID - 10.1016/j.humimm.2012.02.020 [doi]
AB  - Human leukocyte antigen (HLA) antibodies are usually "epitope" and not "antigen" 
      specific. This work presents an interesting case concerning Luminex median 
      fluorescence intensity (MFI) levels in antibodies considered low risk (<1,000), 
      but producing humoral rejection. These low-titer antibodies could play an 
      important role in transplantation. A 42-year-old woman was retransplanted with a 
      deceased donor with negative complement-dependent cytotoxicity cross-matching. 
      Our patient was pretransplant (PrT) sensitized to HLA antigens (single antigens 
      (SA) = 31%) for 1 previous transplant. Thus, the formerly detected sensitized 
      antigens were A32, A30, A31, cross-reacting group 5C, and DQ3 with a MFI(max)  approximately  
      4,127. In the posttransplantation period (PTP), the patient exhibited important 
      instability in renal function and we detected an increased SA percentage (61%) 
      with MFI(max) = 15,029 (A*32) with other antigens (detected with a low PrT MFI 
      [<1,000]) as anti-A*03 (MFI(max) = 13,301) and anti-A*11 (MFI(max) = 13,714) 
      specificities. Anti-A*03 was a donor-specific antibody (DSA). Renal biopsy was 
      compatible with humoral rejection. The patient was pulsed with 
      methylprednisolone, plasmapheresis, and intravenous immunoglobulin without 
      improvement. Thus, we added anti-CD20 and the initial clinical response was 
      highly favorable. Biopsies resulted in suggestive rejection reversion. MFI A*03 
      DSA decreased to 6,908 and later to MFI(max) = 5,505. After a 6-month PTP, the 
      patient is well with MFI(max) = 3,124. It was possible to define exactly the 
      potential immunizing epitope eplets whose recognition determined the specific 
      antibody production. A*32:01, A*30:01, A*31:01 (detected PrT), A*11:01, and 
      A*03:01 (detected PTP) alleles have several shared eplets (62QE, 70AQS, and 
      76VGT), with 62QE being the only eplet present on all alleles. In conclusion, low 
      MFI levels in antibodies considered low risk could be important in posttransplant 
      humoral rejection, although the patient's renal function can be restored. Thus, 
      specific shared eplets should always be investigated with respect to previous 
      transplant mismatches.
CI  - Copyright (c) 2012 American Society for Histocompatibility and Immunogenetics. 
      Published by Elsevier Inc. All rights reserved.
FAU - Bosch, Alexandre
AU  - Bosch A
AD  - Department of Immunology, University Hospital Virgen, Arrixaca, 30120 Murcia, 
      Spain.
FAU - Llorente, Santiago
AU  - Llorente S
FAU - Diaz, Julio A
AU  - Diaz JA
FAU - Salgado, Gema
AU  - Salgado G
FAU - Lopez, Manuela
AU  - Lopez M
FAU - Boix, Francisco
AU  - Boix F
FAU - Lopez-Hernandez, Ruth
AU  - Lopez-Hernandez R
FAU - Gonzalez-Soriano, Maria J
AU  - Gonzalez-Soriano MJ
FAU - Campillo, Jose A
AU  - Campillo JA
FAU - Moya-Quiles, Maria R
AU  - Moya-Quiles MR
FAU - Perez-Lopez, Noelia
AU  - Perez-Lopez N
FAU - Minguela, Alfredo
AU  - Minguela A
FAU - Jimeno, Luisa
AU  - Jimeno L
FAU - Alvarez-Lopez, Maria R
AU  - Alvarez-Lopez MR
FAU - Muro, Manuel
AU  - Muro M
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120306
PL  - United States
TA  - Hum Immunol
JT  - Human immunology
JID - 8010936
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Isoantibodies)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - IM
MH  - Adult
MH  - Antibodies, Monoclonal, Murine-Derived/*administration & dosage
MH  - Biopsy
MH  - Cross Reactions
MH  - Female
MH  - Fluorescence
MH  - Graft Rejection/*prevention & control
MH  - Graft Survival/immunology
MH  - HLA Antigens/*blood/immunology
MH  - Histocompatibility Testing/methods/standards
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage
MH  - Isoantibodies/*blood/immunology
MH  - Kidney/*immunology/pathology
MH  - Kidney Function Tests
MH  - Kidney Transplantation/*immunology/pathology
MH  - Methylprednisolone/administration & dosage
MH  - Plasmapheresis
MH  - Risk Assessment
MH  - Rituximab
EDAT- 2012/03/20 06:00
MHDA- 2013/01/19 06:00
CRDT- 2012/03/20 06:00
PHST- 2011/12/02 00:00 [received]
PHST- 2012/02/24 00:00 [revised]
PHST- 2012/02/27 00:00 [accepted]
PHST- 2012/03/20 06:00 [entrez]
PHST- 2012/03/20 06:00 [pubmed]
PHST- 2013/01/19 06:00 [medline]
AID - S0198-8859(12)00055-9 [pii]
AID - 10.1016/j.humimm.2012.02.020 [doi]
PST - ppublish
SO  - Hum Immunol. 2012 May;73(5):522-5. doi: 10.1016/j.humimm.2012.02.020. Epub 2012 
      Mar 6.