BONE ALLOGRAFTS ARE IMMUNOGENIC AND MAY PRECLUDE SUBSEQUENT ORGAN TRANSPLANTS

The authors report a case of a 41-year-old woman with diabetes and chr onic renal failure in whom antihuman leukocyte antigen antibodies deve loped after she received a frozen bone allograft that limited her acce ss to organ donors, The patient had a chondrosarcoma of the right dist al femur, A wide resection with segmental total knee arthroplasty was followed by a revision using a composite bone allograft prosthesis, Af ter revision, broadly reactive lymphocytotoxic antibodies developed in the patient, The patient's panel reactive antibody level rose from 28 % to a peak of 70%. Panel reactive antibody expresses the percentage o f a panel of human leukocyte antigen type T lymphocytes from 40 indivi duals (representative of all human leukocyte antigen Class I histocomp atibility antigens) to which antihuman leukocyte antigen Class I lymph ocytotoxic antibodies have developed in the recipient as measured by t he antiglobulin crossmatch method, The specificity of the patient's pr imary antibody is found in 45% of donors available in Illinois since 1 988 (N = 1606). Because a positive crossmatch precludes kidney and pan creas transplantation, at least 45% of cadaver organ donors were exclu ded from use for this patient, This is an unusual case that focuses on the potential impact of bone allografts in patients who may need subs equent organ transplantation.