(437) Extreme HLA Homozygosity Contributing to Extreme HLA Sensitization
نویسندگان
چکیده
IntroductionHomozygosity at human leukocyte antigen (HLA) loci is associated with an increased risk of sensitization in kidney transplant candidates. We present a patient HLA homozygosity eight who was significantly sensitized.Case ReportA 43-year-old woman multiple prior pregnancies and non-ischemic cardiomyopathy EF 20% presented decompensated heart failure. She evaluated for found to have class I/II panel reactive antibody (PRA) values 100%/98%. Calculated PRA (cPRA) including only C1q binding antibodies 99% (FIGURE 1). Her genotype demonstrated complete all genotyped alleles (A 30/30, B 65/65, C 8/8, DR 15/15, 51/51, DQ 6/6, DQA1 *01/*01, DPB1 *01/*01). The calculated frequency this the population estimated 1 3.2 × 10−11. underwent desensitization plasmapheresis, rituximab, intravenous immune globulin, daratumumab followed by tocilizumab improvement cPRA 46%. listed transplantation though required durable left ventricular assist device (LVAD) due cardiogenic shock. three months after LVAD 100%. received another six doses immunoglobulin, drop 32%. However, rose 77% 11 later. currently undergoing additional (Fig 1).SummaryWe rare case extreme high broad sensitization. While has other factors sensitization, her likely contributed persistent sensitized state. mechanism association remains unclear. Homozygosity sensitized. A Figure 1: Patient treatment course response.
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ژورنال
عنوان ژورنال: Journal of Heart and Lung Transplantation
سال: 2023
ISSN: ['1053-2498', '1557-3117']
DOI: https://doi.org/10.1016/j.healun.2023.02.452