Management of mixed acute rejection driven by a de novo donor-specific complement-binding anti-DQB1*03:01 antibody and intraepithelial CD8 T-cells in a kidney recipient: a case report

ABSTRACT

Mixed acute rejection is a clinicopathological entity that is difficult to accurately diagnose, and so may be under-reported. Allografts are lost more often than in either humoral or cellular rejection. The diagnosis requires both histological and immunological studies on renal biopsy and blood specimens from the transplant recipient to provide the required rescue therapy to abolish the allogeneic response against the graft. We present a clinical case report of an active mixed acute rejection driven by a de novo donor-specific complement-binding anti-DQB1*03:01 antibody and intraepithelial CD8 T-cells in a patient with a kidney transplant. The patient was diagnosed, treated, and followed up as per the local institution’s procedure with a full recovery of graft function. Our case emphasises the challenge of a mixed acute rejection and supports the need to improve the post-transplant outcome of recipients and their grafts.

KEYWORDS:

• Antibody-mediated rejection
• T-cell mediated rejection
• mixed acute rejection
• complement binding
• desensitization
• donor specific antibodies
• HLA

Acknowledgements

The authors warmly appreciate the generosity of the patient whose case is described in this manuscript. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. This study was approved by the local ethics committee (CEIm PI 2021 01 656).

Disclosure statement

All the authors who participated in this work certify no competing interests in the subject matter or materials discussed in this manuscript.

Additional information

Funding

This work was partially funded by the Gerencia Regional de Salud (GRS) of Castilla y León [GRS 2080/A/19].