Kidney transplant rejection despite zero eplet DR / DQ Mismatch: A case report

IF 2.1 4区医学 Q3 IMMUNOLOGY

Human Immunology Pub Date : 2025-11-01 Epub Date: 2025-10-27 DOI:10.1016/j.humimm.2025.111606

A. Quintiliano , C.H. Cramer , A.J. Bentall , M. Prieto , S.H. Nasr , C.A. Schinstock , M.J. Gandhi

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引用次数: 0

Abstract

Eplet mismatch (MM) quantification is a valuable tool for refining histocompatibility in kidney transplantation, especially at HLA-DR/DQ loci. However, zero MM at these loci does not ensure complete immunological safety. We report a 17-year-old male who received a living donor kidney transplant via the kidney paired donation (KPD) program. The donor had 0 eplet MMs at HLA-DR/DQ, with negative crossmatch and no pre-transplant donor-specific antibodies (DSAs). Despite this, the patient developed early mixed rejection—T cell-mediated (TCMR) and antibody-mediated (ABMR), and further analysis revealed DSAs targeting an HLA-C 80 K/77 N eplet. Combined treatment for TCMR and ABMR led to histological and functional improvement. This case illustrates the limitation of relying solely on HLA-DR/DQ eplet matching. Despite achieving 0 MM at these loci, the patient developed significant alloimmune injury. Molecular MM scores are useful predictive biomarkers, but they do not fully capture the complexity of immune responses in transplantation.

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无eplet DR / DQ不匹配的肾移植排斥反应1例报告。

epet错配（MM）定量是改善肾移植组织相容性的一种有价值的工具，特别是在HLA-DR/DQ位点。然而，这些位点的MM为零并不能保证完全的免疫安全。我们报告一个17岁的男性接受活体肾脏移植通过肾脏配对捐赠（KPD）计划。供者在HLA-DR/DQ上有0个eplet mm，交叉配型阴性，无移植前供者特异性抗体（dsa）。尽管如此，患者出现了早期的混合排斥- t细胞介导（TCMR）和抗体介导（ABMR），进一步的分析显示dsa靶向HLA-C 80 K/77 N等位基因。TCMR和ABMR联合治疗导致组织学和功能改善。这个病例说明了仅仅依靠HLA-DR/DQ序列匹配的局限性。尽管在这些位点达到0 MM，但患者发生了明显的同种免疫损伤。分子MM评分是有用的预测性生物标志物，但它们不能完全捕捉移植中免疫反应的复杂性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Human Immunology 医学-免疫学

CiteScore

5.40

自引率

7.40%

发文量

107

审稿时长

12 days

期刊介绍： The journal''s scope includes understanding the genetic and functional mechanisms that distinguish human individuals in their immune responses to allografts, pregnancy, infections or vaccines as well as the immune responses that lead to autoimmunity, allergy or drug hypersensitivity. It also includes examining the distribution of the genes controlling these responses in populations. Research areas include: Studies of the genetics, genomics, polymorphism, evolution, and population distribution of immune-related genes Studies of the expression, structure and function of the products of immune-related genes Immunogenetics of susceptibility to infectious and autoimmune disease, and allergy The role of the immune-related genes in hematopoietic stem cell, solid organ, and vascularized composite allograft transplant Histocompatibility studies including alloantibodies, epitope definition, and T cell alloreactivity Studies of immunologic tolerance and pregnancy T cell, B cell, NK and regulatory cell functions, particularly related to subjects within the journal''s scope Pharmacogenomics and vaccine development in the context of immune-related genes Human Immunology considers immune-related genes to include those encoding classical and non-classical HLA, KIR, MIC, minor histocompatibility antigens (mHAg), immunoglobulins, TCR, BCR, proteins involved in antigen processing and presentation, complement, Fc receptors, chemokines and cytokines. Other immune-related genes may be considered. Human Immunology is also interested in bioinformatics of immune-related genes and organizational topics impacting laboratory processes, organ allocation, clinical strategies, and registries related to autoimmunity and transplantation.