Acute vascular rejection mediated by HLA antibodies in a cadaveric kidney recipient: discrepancies between FlowPRATM, ELISA and CDC vs luminex screening

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Abstract
Sensitization is defined as the presence of preformed alloantibodies (usually anti-HLA class I antibodies, but sometimes also anti-HLA class II or non-HLA antibodies) in the serum of a prospective transplant recipient. Sensitization is measured by testing the patient's serum for cytotoxicity against a panel of lymphocytes of various HLA types. The donor's vascular endothelium, particularly of the microcirculation, is the major target of alloantibodies. The antibodies’ ability to recruit effector systems—among which are complement, leucocytes, including neutrophils, natural killer cells and macrophages—results in the destruction of target organs [1]. Thus, a positive T-cell cross-match is an absolute contraindication to transplantation, because of the risk of hyperacute rejection and immediate graft dysfunction and loss. Indeed, alloantibodies may cause not only hyperacute rejection, the most severe type of humoral graft injury, but they also may contribute to acute or chronic rejections [2,3].