W.V. is a 57-year-old man who lives with his wife and two teenage sons. W.V. developed chronic kidney
disease 20 years ago after using a drug for migraine headaches that was later shown to cause severe nephrotoxicity. W.V.
underwent hemodialysis for 5 years before receiving a cadaveric transplant, or cadaver
kidney. He recovered without complications, and his serum laboratory values returned to normal. He was
placed on triple immunosuppression therapy, including prednisone (Deltasone), cyclosporine (Imuran),
and tacrolimus (Prograf), and was discharged to home.
What histocompatibility studies are generally performed before renal transplant, and why are
they important?
ABO compatibility and Rh typing (compatibility for red cell ABO antigens): Incompatibility would result
in hyperacute organ rejection.
Human leukocyte antigen (HLA): Evaluates the match of antigens between donor and recipient. The
fewer the mismatches of HLA-A, HLA-B, and HLA-DR antigens, the greater the likelihood of graft
survival and longevity.
White blood cell (WBC) crossmatch test: A positive crossmatch is a contraindication for transplantation
because the result signifies that the patient's immune system has the ability to attack the donor's
cells and most likely would attack the donor's transplanted kidney.
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