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642a)
A patient with end-stage renal disease (ESRD) is evaluated for a living unrelated kidney transplant. The results of histocompatibility testing by solid-phase assays (SPAs) (Luminex with mixed antigen beads) and complement-dependent cytotoxicity (CDC) and flow cytometry (FC) crossmatches between patient sera and patient lymphocytes and between patient sera and donor lymphocytes are shown in the table.

CDC Crossmatch FC Crossmatch Luminex

T cells B cells T cells B cells Class I Class II

Patient cells neg neg neg neg

Donor cells neg neg neg weak pos weak pos neg

Which one of the following best explains these results?

	CDC Crossmatch	FC Crossmatch	Luminex
	T cells	B cells	T cells	B cells	Class I	Class II
Patient cells	neg	neg	neg	neg
Donor cells	neg	neg	neg	weak pos	weak pos	neg

A non-human leukocyte antigen (HLA) antibody. An HLA class I antibody. An HLA class II antibody. An autoantibody. Major-histocompatability-complex (MHC) class I polypeptide-related sequence A (MICA) antigen antibody.

642b)
The results of the pretransplant crossmatch are shown in the table.

CDC Crossmatch FC Crossmatch Luminex

T cells B cells T cells B cells Class I Class II

Crossmatch w/donor neg neg neg neg neg neg

The transplant proceeds and the patient undergoes induction therapy with rituximab. If the testing were repeated 1 week after transplant, what would the results most likely show?

	CDC Crossmatch	FC Crossmatch	Luminex
Crossmatch w/donor	neg	neg	neg	neg	neg	neg

	CDC Crossmatch	FC Crossmatch	Luminex
Crossmatch w/donor	neg	neg	neg	neg	neg	neg

CDC Crossmatch FC Crossmatch Luminex

T cells B cells T cells B cells Class I Class II

Crossmatch w/donor neg neg neg neg neg neg

Crossmatch w/donor neg pos neg pos weak pos neg

Crossmatch w/donor pos pos pos pos weak pos neg

Crossmatch w/donor neg neg neg pos neg pos

642c) Which one of the following tests offers additional information about the anti-human leukocyte antigen (HLA) class I antibody present in this serum, complementing the testing results described in the previous question?

Panel reactive antibodies (PRAs). Luminex/solid-phase assay (SPA) with single antigen beads. T- and B-cell CDC crossmatch with anti-human globulin. High-resolution typing of the recipient and donor.

Clinical Pathology: General Principles, Immunology & Histocompatibility

642c) Which one of the following tests offers additional information about the anti-human leukocyte antigen (HLA) class I antibody present in this serum, complementing the testing results described in the previous question?

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