Desoutter Judith, Apithy Marie-Joëlle, Bartczak Ségolène, Guillaume Nicolas
Department of Histocompatibility, Amiens University Medical Center, 80000 Amiens, France.
Case Rep Transplant. 2016;2016:4534898. doi: 10.1155/2016/4534898. Epub 2016 Apr 28.
Crossmatching is essential prior to kidney transplantation to confirm compatibility between the donor and the recipient, particularly to prevent acute antibody-mediated rejection. An unexpected positive crossmatch may be obtained in recipients with an autoimmune disease or preexisting antibodies not detected by single-antigen bead array due to complement interference or who have been previously treated by desensitization protocols such as rituximab, antithymocyte globulin, or intravenous immunoglobulins. We report donor and recipient investigations that revealed unexpected positive B-cells crossmatch, probably due to donor cells, as the donor had received rituximab therapy shortly before organ harvesting, in a context of severe idiopathic thrombocytopenic purpura. We consequently detected unexpected Class II IgG complement-dependent cytotoxicity for all sera tested. Other laboratory investigations failed to elucidate the reasons for this recipient-related positivity.
在肾移植前进行交叉配型至关重要，以确认供体和受体之间的相容性，特别是为了预防急性抗体介导的排斥反应。在患有自身免疫性疾病的受体中，或由于补体干扰，通过单抗原珠阵列未检测到预先存在的抗体的受体中，或之前接受过诸如利妥昔单抗、抗胸腺细胞球蛋白或静脉注射免疫球蛋白等脱敏方案治疗的受体中，可能会获得意外的阳性交叉配型结果。我们报告了供体和受体的调查情况，结果显示出现了意外的B细胞阳性交叉配型，可能是由于供体细胞导致的，因为在严重特发性血小板减少性紫癜的情况下，供体在器官获取前不久接受了利妥昔单抗治疗。因此，我们检测到所有测试血清中出现了意外的II类IgG补体依赖性细胞毒性。其他实验室检查未能阐明这种与受体相关的阳性结果的原因。
