Successful kidney transplant in patient with positive crossmatch due to autoantibodies

Prior to kidney transplantation a young woman was found to have lymphocytotoxic antibodies to an HLA/mixed lymphocyte culture identical sib donor. The serum killed 75% of the lymphocytes at 22 C but was unreactive at 37 C. At room temperature it was cytotoxic for many lymphocytes of a random panel and also reacted with the recipient’s own cells. Complement was required for cytotoxicity. Absorption with lymphocytes but not with platelets abolished the reaction. The antibodies disappeared spontaneously and the transplant was performed. There was no evidence of rejection and at 6 months the kidney is in excellent condition. Cold-reactive lymphocyte specific autoantibodies causing a positive crossmatch could be distinguished from anti-HLA antibodies and did not preclude a successful kidney transplant.