Accelerated rejection following offspring-to-mother and husband-to-wife transplants

It has been demonstrated that graft survival rates of offspring-to-mother and husband-to-wife renal transplants are equivalent to those of other living donors. Although the vast majority of these transplants proceed without incident, we have encountered several instances of delayed accelerated rejections that are not predicted by a positive cross-match. The accelerated rejection can result from an anamnestic reaction subsequent to the in utero exposure of the mother to human leukocyte antigen (HLA) antigens of the fetus with sensitization developing during the pregnancy.