Accelerated Rejection of a Renal Allograft Associated with Pretransplantation Antibodies Directed against Donor Antigens on Endothelium and Monocytes

HUMAN renal allografts may be rejected within hours after transplantation. This type of rejection is usually associated with pre-existing antibodies against donor ABO-group antigens or lymphocyte antigens.1 , 2 The importance of pre-existing antibodies against donor B-cell antigens is, however, a subject of controversy.3 This report concerns an allograft recipient with preexisting antibodies directed against endothelial antigens, which were also present on monocytes but not on lymphocytes; the graft was rejected immediately after transplantation. In previous studies we established the association between endothelial antibodies and irreversible vascular rejection.4 , 5 The present study suggests that these antibodies are the cause, rather than a consequence, . . .