Abstract
Atypical non HLA antibodies are increasingly recognised as causes of immunological injury in allotransplantation. In this report we describe a non HLA sensitized male renal allograft recipient who developed acute vascular rejection on a "for cause" biopsy (Banff v2, g2, ptc 3) at day 4 post first renal allograft in the presence of elevated angiotensin II type 1 receptor antibodies (AT1R-Ab level 14.1). The acute rejection was treated with pulse corticosteroid therapy, anti-thymocyte globulin (ATG × 6), plasma exchange (1.5 plasma volume replacement x6) and oral candesartan. Serum creatinine improved and follow up biopsy confirmed resolution of rejection following treatment. AT1R-Ab should be considered when rejection is diagnosed in the absence of HLA antibodies.
Keywords:
atypical antibody; non HLA antibodies; rejection; vascular.
© 2015 Asian Pacific Society of Nephrology.
MeSH terms
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Acute Disease
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Administration, Oral
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Adrenal Cortex Hormones / administration & dosage
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Adult
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Allografts
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Angiotensin II Type 1 Receptor Blockers / administration & dosage
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Antilymphocyte Serum / administration & dosage
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Autoantibodies / blood*
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Benzimidazoles / administration & dosage
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Biopsy
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Biphenyl Compounds
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Graft Rejection / diagnosis
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Graft Rejection / immunology*
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Graft Rejection / therapy
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Humans
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Immunosuppressive Agents / administration & dosage
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Kidney Transplantation / adverse effects*
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Male
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Plasma Exchange
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Pulse Therapy, Drug
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Receptor, Angiotensin, Type 1 / drug effects
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Receptor, Angiotensin, Type 1 / immunology*
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Severity of Illness Index
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Tetrazoles / administration & dosage
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Time Factors
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Treatment Outcome
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Up-Regulation
Substances
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AGTR1 protein, human
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Adrenal Cortex Hormones
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Angiotensin II Type 1 Receptor Blockers
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Antilymphocyte Serum
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Autoantibodies
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Benzimidazoles
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Biphenyl Compounds
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Immunosuppressive Agents
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Receptor, Angiotensin, Type 1
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Tetrazoles
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candesartan