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Early Graft Dysfunction After Living Donor Kidney Transplant
Neeraj Sharma1, Thanh Cao, Ranvir Bajwa
1From the Department of Nephrology, USC Transplant, University of Southern California, Los Angeles, California, USA.
Summary
Early acute cellular rejection (Banff 2A) occurred 24 hours post-transplant in a low-risk living donor kidney transplant recipient. This highlights the potential impact of HLA mismatches on graft outcomes, even with compatible blood types and negative crossmatches.
Area of Science:
- Nephrology
- Transplantation immunology
- Clinical case study
Background:
- Living donor kidney transplantation aims for immediate graft function.
- ABO-compatible, HLA crossmatch-negative transplants are typically low-risk.
- Early acute rejection can compromise long-term allograft survival.
Observation:
- A case of Banff 2A cellular rejection occurred 24 hours after a living donor kidney transplant.
- The recipient was ABO blood group-compatible and HLA crossmatch-negative.
- The patient was considered low-risk for acute rejection.
Findings:
- The early acute rejection in this low-risk patient is speculated to be linked to Human Leukocyte Antigen (HLA) mismatches.
- Basiliximab induction therapy might have contributed to the rejection episode.
- This case challenges the standard risk assessment for kidney transplants.
Implications:
- Consideration for more intensive induction therapy in low-risk kidney transplant recipients with HLA mismatches.
- Further investigation into the role of HLA mismatches in early acute rejection.
- Evaluating the long-term allograft outcomes following early acute rejection episodes in kidney transplantation.
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