Journal
PEDIATRIC TRANSPLANTATION
Volume 15, Issue 1, Pages E1-E7Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1399-3046.2010.01407.x
Keywords
antibody-mediated rejection; donor-specific anti-MICA antibody; anti-MICA antibody; highly sensitized patient; non-HLA antibody
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Funding
- Casey Lee Ball Foundation
- National Kidney Foundation of Southern California
- National Institute of Allergy and Infectious Diseases [RO1 AI 042819]
- NIH [U01AI077821]
- National Heart Lung and Blood Institute [RO1 HL 090995]
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Allograft rejection in HLA identical transplant recipients and in patients without detectable donor-specific anti-HLA antibodies has lead to the identification of non-HLA antigens as targets of the alloimmune response. MICA antigen has been recognized as an important non-HLA target in renal transplantation. Recent studies have shown that anti-MICA antibodies are associated with acute renal allograft rejection and failure. Current cross match procedures using donor lymphocytes fail to detect MICA antibodies. Transplant candidates are not routinely tested for pre-sensitization to MICA antigens nor are transplant donors typed for MICA alleles. Optimal classification and treatment of acute rejection associated with MICA antibody remains unknown. In this case report, we are the first to describe the clinical course and treatment of donor-specific MICA antibody associated with both Banff type II A ACR and AMR in a highly sensitized pediatric renal re-transplant recipient. This case also emphasizes the importance of pre-transplant screening for donor-specific MICA antibody especially in highly sensitized renal transplant patients.
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