Pertinent history:
(1) The patient was Jka (Kidd) negative.
(2) The patient received a renal transplant from a Jka-positive sister.
(3) The patient had been immunized to Jka after receiving blood from her Jka-positive father.
(4) The patient received Jka-positive blood that was compatible.
(5) After receiving the blood the patient demonstrated anti-Jka in her serum, followed by acute rejection of the transplant.
Facts:
(1) Kidd antigen is expressed on endothelial cells in the renal medulla.
(2) The Kidd protein acts as a urea transport protein and is similar to the urea transport protein in the kidney.
The chances of such an event can be reduced by:
(1) keeping the number of transfusions to a minimum
(2) selecting blood that matches the patient’s phenotype as closely as possible
(3) avoiding products that have antigens absent in the recipient but expressed on the transplanted organ
