Accelerated Rejection of a Renal Allograft Associated with Pretransplantation Antibodies Directed against Donor Antigens on Endothelium and Monocytes

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Abstract
HUMAN renal allografts may be rejected within hours after transplantation. This type of rejection is usually associated with pre-existing antibodies against donor ABO-group antigens or lymphocyte antigens.1 , 2 The importance of pre-existing antibodies against donor B-cell antigens is, however, a subject of controversy.3 This report concerns an allograft recipient with preexisting antibodies directed against endothelial antigens, which were also present on monocytes but not on lymphocytes; the graft was rejected immediately after transplantation. In previous studies we established the association between endothelial antibodies and irreversible vascular rejection.4 , 5 The present study suggests that these antibodies are the cause, rather than a consequence, . . .