Anti-donor DR103 Immunization in a DRB1*0101 kidney allograft recipient

Area of Science:

• Transplantation immunology
• Histocompatibility

Background:

• Donor-specific anti-HLA antibodies post-kidney transplant are linked to reduced graft survival.
• Understanding HLA allele compatibility is crucial for successful transplantation.

Observation:

• A kidney transplant recipient with HLA-DRB1*0101 developed anti-DR103 antibodies after receiving an organ from a rare HLA-DRB1*0103 donor.
• This specific HLA-DRB1*0103 allele differs from HLA-DRB1*0101 by only three amino acid substitutions.

Findings:

• The HLA-DRB1*0103 donor organ induced alloimmunization in the HLA-DRB1*0101 recipient.
• This alloimmunization resulted in the loss of the kidney allograft.

Implications:

• Rare HLA alleles can pose unique immunization risks in kidney transplant recipients.
• Pre-transplant screening and post-transplant monitoring should consider potential immunogenicity of rare HLA mismatches.