PMID- 28953652
OWN - NLM
STAT- MEDLINE
DCOM- 20171016
LR  - 20220419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 39
DP  - 2017 Sep
TI  - Successful kidney transplantation across a positive complement-dependent 
      cytotoxicity crossmatch by using C1q assay-directed, bortezomib-assisted 
      desensitization: A case report.
PG  - e8145
LID - 10.1097/MD.0000000000008145 [doi]
LID - e8145
AB  - RATIONALE: Human leukocyte antigen (HLA) is the major immunologic barrier in 
      kidney transplantation (KT). Various desensitization protocols to overcome the 
      HLA barrier have increased the opportunity for transplantation in sensitized 
      patients. In addition, technological advances in solid-phase assays have 
      permitted more comprehensive assessment of donor-specific antibodies. Although 
      various desensitization therapies and immunologic techniques have been developed, 
      the final transplantation decision is still based on the classic 
      complement-dependent cytotoxicity (CDC) crossmatch (XM) technique. Some patients 
      who fail to achieve negative XM have lost their transplant opportunities, even 
      after receiving sufficient desensitization therapies. PATIENT CONCERNS: A 
      57-year-old male with end-stage renal disease secondary to chronic 
      glomerulonephritis was scheduled to have a second transplant from his son, but 
      CDC XM was positive. DIAGNOSES: Initial CDC XM (Initial T-AHG 1:32) and 
      flow-cytometry XM were positive. Anti-HLA-B59 donor specific antibody was 
      detected by Luminex single antigen assay. INTERVENTIONS: Herein, we report a 
      successful case of KT across a positive CDC XM (T-AHG 1:8 at the time of 
      transplantation) by using C1q assay-directed, bortezomib-assisted 
      desensitization. After confirming a negative conversion in the C1q donor-specific 
      antibody, we decided to perform KT accepting a positive AHG-CDC XM of 1:8 at the 
      time of transplantation. OUTCOMES: The posttransplant course was uneventful and a 
      protocol biopsy at 3 months showed no evidence of rejection. The patient had 
      excellent graft function at 12 months posttransplant. LESSONS: The results of XM 
      test and solid-phase assay should be interpreted in the context of the individual 
      patient.
FAU - Lee, Juhan
AU  - Lee J
AD  - Department of Transplantation Surgery, Severance Hospital, Yonsei University 
      Health System Department of Laboratory Medicine, Severance Hospital, Yonsei 
      University Health System Department of Pathology, Severance Hospital, Yonsei 
      University Health System Department of Nephrology, Severance Hospital, Yonsei 
      University Health System Department of Surgery, Yonsei University College of 
      Medicine, Seoul, Republic of Korea.
FAU - Park, Borae G
AU  - Park BG
FAU - Jeong, Hyang Sook
AU  - Jeong HS
FAU - Park, Youn Hee
AU  - Park YH
FAU - Kim, Sinyoung
AU  - Kim S
FAU - Kim, Beom Seok
AU  - Kim BS
FAU - Kim, Hye Jin
AU  - Kim HJ
FAU - Huh, Kyu Ha
AU  - Huh KH
FAU - Jeong, Hyeon Joo
AU  - Jeong HJ
FAU - Kim, Yu Seun
AU  - Kim YS
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-B59 antigen)
RN  - 0 (Histocompatibility Antigens)
SB  - IM
MH  - Desensitization, Immunologic/*methods
MH  - *Graft Rejection/immunology/prevention & control
MH  - HLA-B Antigens/*analysis
MH  - Histocompatibility Antigens/analysis
MH  - Histocompatibility Testing/*methods
MH  - Humans
MH  - *Kidney Failure, Chronic/immunology/surgery
MH  - *Kidney Transplantation/adverse effects/methods
MH  - Male
MH  - Middle Aged
MH  - Preoperative Care/methods
MH  - Treatment Outcome
PMC - PMC5626295
COIS- The authors report no conflicts of interest.
EDAT- 2017/09/28 06:00
MHDA- 2017/10/17 06:00
PMCR- 2017/09/29
CRDT- 2017/09/28 06:00
PHST- 2017/09/28 06:00 [entrez]
PHST- 2017/09/28 06:00 [pubmed]
PHST- 2017/10/17 06:00 [medline]
PHST- 2017/09/29 00:00 [pmc-release]
AID - 00005792-201709290-00045 [pii]
AID - MD-D-17-01515 [pii]
AID - 10.1097/MD.0000000000008145 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Sep;96(39):e8145. doi: 10.1097/MD.0000000000008145.