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G Ital Nefrol ; 26 Suppl 45: S58-63, 2009.
Article in Italian | MEDLINE | ID: mdl-19382096

ABSTRACT

Immunological evaluation by panel reactive antibody (PRA) and determination of anti-HLA specificity is an important phase in the assessment of patients awaiting kidney transplant. The main causes of immunization are previous solid organ transplants, blood transfusions, and pregnancy; immunogenicity can also be triggered by vascularized tissue grafts. Immune induction by cryopreserved bone allografts is not yet fully understood. We report the case of a 19-year-old patient with osteosarcoma who underwent resection of the left proximal tibia with reconstruction using human bone in 1997 (donor typing: A3, A29 (19) - B44 (12), Bw4 - DR13 (6), DR7, DR52, DR53). The patient was subsequently placed on the waiting list for a cadaver donor kidney transplant because of chronic kidney failure caused by cisplatin toxicity. Pretransplant immunological screening using the CDC (complement dependent cytotoxicity) technique revealed a PRA of 63% and anti-A3 and anti-A68 antibodies. The presence of IgG antibody specificity against class I and class II donor antigens (specifically anti-A3, B44, DR7 antibodies) was highlighted using flow cytometry (Tepnel-Luminex). Further immunological studies using single HLA specificity analysis (LSA Class I - II - Tepnel-Luminex) detected direct antibodies against all donor antigen specificities. This is the first reported case of immune induction after a bone graft in a kidney transplant candidate. It underlines the importance of the availability of HLA typing data of all human allograft donors.


Subject(s)
Cisplatin/adverse effects , HLA Antigens/immunology , Histocompatibility Testing/methods , Immunosuppressive Agents/adverse effects , Isoantibodies/immunology , Kidney Failure, Chronic/chemically induced , Kidney Failure, Chronic/immunology , Kidney Transplantation/immunology , Bone Neoplasms/surgery , Bone Transplantation/adverse effects , Cisplatin/administration & dosage , Female , Flow Cytometry , Graft Rejection , Graft Survival , Histocompatibility/immunology , Humans , Immunosuppressive Agents/administration & dosage , Isoantibodies/blood , Kidney Failure, Chronic/surgery , Osteosarcoma/surgery , Preoperative Care , Tibia/surgery , Young Adult
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