Antibody Mediated Acute Renal Allograft Rejection- A Unique Case

We report here a case of acute rejection of renal transplant in a forty nine year old female. The renal biopsy showed distension of glomerular capillaries with thrombi. The morphological features suggest accelerated antibody mediated rejection process despite negative cross match. Similar phenomenon noted earlier by other authors has been attributed to endothelial antigen involvement. However, this phenomenon is distinctly rare. Bahrain Med Bull 2001;23(4):183-84. Acute renal allograft rejection continues to affect the survival of nearly 27 % of living related transplants and 30 % of cadaver transplants despite the careful pre and post transplant care and strict application of protocols1. Acute rejection events occurring within 60 days of transplantation carry bad prognosis for the long term survival of the allograft, however, vigorous the anti-rejection therapy may be. We report a case of acute renal allograft rejection in 46 years old Bahraini female. Histopathological analysis proved to be accelerated antibody mediated rejection with negative cross match. THE CASE Forty six year old Bahraini female underwent renal transplant on November 30th 1999 for end stage renal disease secondary to hypertension. The donor was her healthy daughter. The Human Leucocyte Antigen (HLA) profile of the patient and the donor was as follows