Antibody-mediated rejection of transplanted kidney associated with anti-Jka alloantibodies: An interesting case report with review of literature.

There is increasing evidence for renal expression of non-ABO minor blood group antigens on the renal endothelium of the vasa recta and tubular epithelial cells. The role of antibodies to minor blood group antigens posing as an immunological risk to the transplanted allograft is under-recognized. We present one interesting case of a 40-year-old male patient who developed antibody-mediated rejection (AMR), leading to graft loss despite multiple interventions. Interestingly, he was found to have antibodies to the Kidd red-cell antigen, Jka, which later was found to be also present in his kidney donor. In the absence of anti-HLA antibodies, we believe preformed donor-specific anti-Jka antibodies best explain AMR in our case. With our case report, we want to highlight the catastrophic potential of antibodies against blood group antigens expressed on renal allografts in donor-recipient mismatched pairs, especially when these antibodies are already present in the recipient.