Published in:
Open Access 01-12-2022 | Thrombotic Microangiopathy | Case report
Late antibody-mediated rejection in a kidney transplant recipient: COVID 19 induced?
Published in: BMC Nephrology | Issue 1/2022
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Background
Antibody-mediated rejection (AMR) was described in kidney transplant patients after viral infections, such as the cytomegalovirus. Very few cases were recently reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, probably in the context of lowering of immunosuppressive therapy. To date, no direct immunological link was proved to explain a connection between the coronavirus disease 19 (COVID-19) infection and antibody-mediated rejection (AMR) if it exists.
Case presentation
Here we try to find this association by presenting the case of a low immunological risk patient who presented, six years post-transplant, with c4d negative antibody mediated rejection due to an anti-HLA-C17 de novo donor specific antibody (DSA) after contracting the coronavirus disease 19.
The HLA-Cw17 activated the antibody-dependent cell-mediated cytotoxicity via the KIR2DS1 positive NK cells.
Discussion and conclusions
This case report may
prove a direct role for COVID-19 infection in AMRs in the kidney transplant
recipients, leading us to closely monitor kidney transplant recipients,
especially if they have “at-risk” donor antigens.