A 44-Year-Old Man with Diabetic Nephropathy Undergoes a Renal Transplant

A 44-year-old man with diabetic nephropathy undergoes a renal transplant.  One week later, he develops low-grade fever, body aches, and decreased urine output.  Temperature is 37.2 C (99 F) , blood pressure is 124/76 mm Hg, and pulse is 88/min.  Physical examination shows mild tenderness over the graft on palpation.  Serum creatinine is 2.2 mg/dL, an increase from 1.2 mg/dL two days ago.  Arterial and venous Doppler studies reveal adequate graft perfusion.  Graft biopsy demonstrates dense interstitial infiltration by mononuclear cells.  Which of the following is the most likely cause of this patient's current condition?

A) Graft B-cell sensitization against host MHC antigens
B) Graft T-cell sensitization against host MHC antigens
C) Host B-cell sensitization against graft MHC antigens
D) Host T-cell sensitization against graft MHC antigens
E) Preformed antibodies against graft ABO antigens

Correct Answer:

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