A transfusion medicine physician at an academic center in Maryland reports that they have recently encountered a patient with anti-Jk(a) who is a candidate for a living related renal transplant. The donor is positive for Jk(a). The Maryland physician has learned that the Kidd antigen has been localized to the renal medulla (Sands JB, J Membr Biol - Feb 2003) and is concerned that the Kidd alloantibody may affect the survival of the kidney and graft function. A literature review has not uncovered any reports of the role of Kidd antibodies in solid organ transplants. The Maryland physician would appreciate any input from colleagues about experience with the Kidd antibody and its potential clinical significance for a renal transplant.

The following responses have been received.

ADDENDA July 23, 2003

1. Dr. Breanndan Moore at the Mayo Clinic (attribution used with permission) reports that in the absence of literature indicating a clinical problem, they have transplanted several such patient/donor combinations over the years and none of them displayed any evidence of hyperacute, early humoral rejection or accelerated rejection. They speculated that the antigens were either not expressed on the vital endothelial cells or, if that was not the case, that their cell surface configuration was such that the antibodies could not attach in a fashion which would allow complement fixation and all the ensuing vascular rejection process emanating from that fixation. Speculation aside, the fact is that in the experience reported by Dr. Moore, the Jk(a) serological incompatibility seemed not to be clinically relevant as far as the allograft was concerned.

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Ira A. Shulman, MD
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