Indah Adhita Wulanda, Dominica Pita Sari, Hani Susianti, Betty Agustina Tambunan
Kidney transplantation is a treatment option for end-stage chronic kidney failure, with success highly dependent on immunoscreening to minimize rejection risks. Transplant rejection can result from antibody-mediated or cellular immune responses. Acute rejection is commonly associated with donor-specific anti-Human Leukocyte Antigen antibodies (HLA-DSA) but can also occur without HLA-DSA. A 63-year-old male undergoing routine hemodialysis in preparation for a kidney transplant presented with anemia, a Coombs test of +2, low estimated Glomerular Filtration Rate (eGFR), decreased C3 levels, and elevated potassium, creatinine, and urea. Immunoscreening showed an HLA match score of 3/16, a negative virtual cross-match, and 0% calculated Panel Reactive Antibody (cPRA). However, Complement-Dependent Cytotoxicity (CDC) cross-match revealed 36%-40% lysis in T lymphocytes and 24%-35% in B lymphocytes. Anti-Nuclear Antibody Immunofluorescence (ANA IF) showed a fine-speckled nuclear pattern (1:80), while all tested autoantibodies were negative. CDC auto-cross-match was also positive in both B and T lymphocytes. These findings suggest antibody reactivity against donor cells, likely due to non-HLA antibodies. Such antibodies can increase the risk of hyperacute rejection by 30%-40%, emphasizing the need for additional perioperative management, including desensitization therapy (plasmapheresis, intravenous immunoglobulin, or rituximab) and post-transplant antibody monitoring. Further evaluations, such as advanced autoantibody panels and endothelial cell cross-matching, are crucial to assess and mitigate rejection risks. © 2025 by SPC (Sami Publishing Company).
Clinical Pathology Sub Specialist Doctor Education Program, Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Brawijaya, dr. Saiful Anwar Hospital, Malang, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Department of Clinical Pathology, Faculty of Medicine, Krida Wacana Christian University, Jakarta, Indonesia; Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
