MHC Class I Related Chain A (MICA) Antibodies - A Potential Cause of Renal Allograft Rejection

MHC class I related chain A (MICA) antibodies, especially those directed against the donor in absence of donor-specific anti-HLA antibodies have been reported to be possibly associated with renal allograft rejection in sensitized recipients. We are the first ones to present a case series of five patients who underwent primary live related donor renal transplantation in non-sensitized recipients either in the presence of donor-specific MICA antibodies (MICA-DSA) or developed de novo. Four of them presented characteristics of either accelerated, acute or chronic antibody-mediated rejection (AMR) attributable to the presence of MICA DSA. This case series emphasizes that AMR due to MICA-DSA is amenable to treatment with conventional regimens for treatment of AMR and there is a need for screening of MICA antibodies especially those directed against the donor on case to case basis.