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The article discusses the case of a 25 year old male presented with rapid worsening of the kidney function with serum creatinine of 3.5 mg/dl. Tubulointerstitial compartment indicated acute tubular injury with moderate patchy interstitial infiltrate occupying 20-25% of the sampled cortex which showed the prominence of plasma cells. He was diagnosed with antibody mediated rejection (AMR) and treated with 3 sessions of plasma exchange and 3mg/kg anti-thymocyte globulin (ATG).

Organ donors are sometimes found "unsuitable" due to the presence of donor-specific anti-HLA antibodies in the recipient. In recent years, improved desensitization protocols have successfully helped to overcome HLA incompatibility hurdle. We present three cases where optimum desensitization was achieved in patients with the donor-specific anti-HLA antibody (DSA) leading to successful renal transplantation. All patient--donor pair underwent HLA typing, complement dependent cytotoxicity crossmatch (CDC-XM), flow cytometry XM (FC-XM), and panel reactive antibody. If any of the three tests was positive, single antigen bead assay was performed to determine the specificity of the anti-HLA antibody (s). Patients with DSA were offered organ-swap or anti-HLA antibody desensitization followed by transplantation. Desensitization protocol consisted of single dose rituximab and cascade plasmapheresis (CP) along with standard triple immunosuppression. The target DSA mean fluorescence index (MFI) was <500, along with negative CDC-XM and FC-XM for both T- and B-cells. Three patients with anti-HLA DSA, who did not find a suitable match in organ swap program, consented to anti-HLA antibody desensitization, followed by transplantation. Mean pre-desensitization antibody MFI was 1740 (1422-2280). Mean number of CP required to achieve the target MFI was 2.3 (2-3). All the three patients are on regular follow-up and have normal renal function test at a mean follow-up of 8 months. This report underlines successful application of desensitization protocol leading to successful HLA-antibody incompatible renal transplants and their continued normal renal functions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the use of NEUT-X and NEUT-Y parameters in neutrophil dysplasia detection suspected with myelodysplastic syndrome (MDS), megaloblastic anemia (MA), and myeloproliferative neoplasm (MPN).