HYPERACUTE REJECTION OF KIDNEY TRANSPLANTATION IN RSCM-JAKARTA: A CASE SERIES

I ARSANA1, M MARBUN1,2
1Department of Internal Medicine, School of Medicine, Universitas Indonesia, Jakarta, Indonesia, 2Division of Nephrology and Hypertension, Departement of Internal Medicine, School of Medicine, Universitas Indonesia, RSCM-Jakarta, Indonesia, Jakarta, Indonesia

Background: Hyperacute rejection (HAR) is a rare event in kidney transplantation (KT). HAR can be prevented by crossmatch tests to detect anti-human leukocyte antigen (anti-HLA) antibodies against the donor. The circulating cytotoxic IgG HLA antibodies of recipient is mostly produced in previous failed kidney graft, blood transfusions, or pregnancy.
Case series: Case I: A 51-year-old male who had end stage renal disease (ESRD) caused by diabetic nephropathy, underwent second KT, crossmatch was 20-30%, and had previous failed kidney graft. Donor was 29-year-old male, unrelated relationship. Recipient underwent preparation with risk procedure protocol. After revascularization, allograft kidney become cyanotic and edematous by hyperacute rejection. Allograft kidney was removed by nephrectomy. Case II: A 41-year-old male who had ESRD cause by glomerulonephritis, underwent second KT, crossmatch was 30%, and had previous failed kidney graft. Donor was 25-year-old male, unrelated relationship. Recipient underwent preparation protocol with risk procedure. After revascularization, allograft kidney become cyanotic due to hyperacute rejection. Allograft kidney was removed by nephrectomy.
Conclusion: Previous failed kidney graft was higher risk to HAR of KT, although the risk procedure protocol had done. In recipient with a previous failed kidney graft, more comprehensive test is suggested to detect anti-HLA antibodies beside crossmatch.


Biography:
IP Arsana Fellow Students of Division of Nephrology and Hypertension, Department of Internal Medicine, School of Medicine, Universitas Indonesia, Jakarta.
Year: 2016 until now.

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