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Poster presented at: American Society for Histocompatibility and Immunogenetics (ASHI) conference.

AIM: A 66 year old female with an end-stage NYHA class IV inotrope-dependent, ischemic cardiomyopathy received a heart transplant on 9-12-09 from a doctor having antigens B13 and DR7. Pre-transplant antibody testing indicated only weakly positive, non-complement fixing donor-specific antibodies. The patient suffered a cardiac arrest on POD#6 and was resuscitated. She was in cardiogenic shock from allograft failure and subsequently expired on POD#9 of multiorgan failure due to "acute humoral rejection". These antibodies were investigated further.

METHODS: Antibodies were evaluated using Labscreen PRA (One Lambda), Labscreen Single Antigen (One Lambda) beads, and C1q Single Antigen (One Lambda) beads, and crossmatching was performed using standard T and B cell CDC and flow cytometry methods.

RESULTS: Pre-transplant antibody studies (Labscreen PRA) had shown the presence of clearly defined antibodies to B27, DR4 and a possible weak anti-DR7. Retrospective Labscreen Single Antigen (SA) (One Lambda) testing revealed antibodies to B13 and DR7, both donor-specific antibodies. MFI values were 2000 for B13 and 5000 for DR7. The pre-transplant crossmatches (CDC and flow cytometry) were negative except for a positive B cell CDC. The patient received blood products on POD#3 and was noted to be in acute renal insufficiency. Crossmatching on POD#3 showed only a weakly positive T flow crossmatch and negative DSA. However, SA antibody studies on POD#6 showed high MFI values of 19,000 (B13) and 23,000 (DR7), and strongly positive T and B CDC and flow crossmatches. C1q studies of sera from POD#0 and #3 showed the DSA were non-complement fixing. However, by POD#6 the DS antibodies were not clearly complement-fixing. The patient expired on POD#9. Myocardium tissue from the left ventricle taken at autopsy showed positive staining for C4d.

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