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De novo production of donor-specific anti-HLA alloantibodies in early acute humoral renal allograft rejection.

This case series demonstrates the importance of reliable and rapid identification of antibody-mediated rejection, which has become a team effort with transplant clinician, pathologist and immunologist contributing important information. Case #1 and #3, male patients without any immunological risk factors, show that standard immunosuppression including mycophenolate may not be sufficient to prevent early de novo production of donor reactive alloantibodies. The renal transplant could be rescued only in half of the patients despite intensified and prolonged therapy, demonstrating the destructive potential of the humoral rejection pathway. Nevertheless, a sensitive and stringent screening for de novo synthesised donor-reactive alloantibodies seems advisable also in the early post-transplant period, in order to initiate anti-humoral rejection therapy as early as possible.