Positive autologous crossmatches and a successful transplant with an HLA-identical, but not with an HLA-nonidentical, kidney.

A kidney graft from an HLA-nonidentical donor following a positive crossmatch in the presence of autoantibodies was rejected, but a subsequent graft from an HLA-A, B, C, DR-identical donor, also following a positive crossmatch, survives. Cytotoxic reactivity was present at 4 C and 37 C, and required complement. Sucrose gradient fractionation showed that most of the reactivity resided in the IgM fraction of the serum. Reactivity with donor T and B lymphocytes was not removed by absorption with platelets. Absorption with autologous lymphocytes failed to remove reactivity to lymphocytes of the first (non-HLA-identical) donor and T and B cells of another individual with the same HLA type as the first donor, although removing reactivity to T, but not to B cells of the second (HLA-identical) donor. This case demonstrates that the presence of a multitude of cold-reactive and warm-reactive T and B cell autoantibodies and non-HLA alloantibodies creates an immunological environment in which only the optimally matched graft will survive.