Introduction: Presence of MHC class 1 chain-related (MICA) alloantibodies can be associated with worse graft outcomes in kidney transplant (KT). In this study, we bring out the first ever data from the central India region to find the incidence of positivity of anti-MICA antibodies and report their impact on graft outcomes.
Methods: We retrieved the data from the transplant immunology set-up from our intuition in central India. All patients tested for anti-MICA antibodies were included for further evaluation. Anti-MICA antibody testing was performed using the Luminex platform. Graft function was assessed by serum creatinine levels.
Results: From a total of 104 patients tested, 23 (22.1%) were positive for anti-MICA antibodies. Among them, 12 (52.2%) have undergone KT. The mean age was 40.5±16.2 years and 8 (75.0%) were males. Diagnosis of anti-MICA antibodies was done pre- and post-transplant in 8 (66.7%) and 4 (33.3%) patients, respectively. Antibody mediated rejection (ABMR) occurred in 3 (25.0%) patients which was attributable to anti-MICA antibodies in two patients, and one had both anti-MICA and class II donor specific antibodies. One patient with ABMR due to anti MICA antibodies responded to treatment with plasma exchange, IVIg infusion & Rituximab. Second patient with ABMR due to anti MICA antibodies was not treated aggressively in view of ongoing infection. Graft loss did not occur in either patient. The mean creatinine level in these three patients was 1.4±0.4 mg/dL (median follow-up: 31.3 weeks). At a median follow-up of 29.1 weeks, there was no ABMR in 9 patients without anti MICA antibodies and their mean serum creatinine was 1.7±0.7 mg/dL. Death with functioning graft occurred in one patient without anti MICA antibodies because of severe pyelonephritis. 
Conclusion: Incidence of positive anti-MICA antibodies in our data from central India is 22%. Pre-transplant evaluation of these antibodies should be done to reduce the risk of antibody mediated graft rejection in KT recipients. Despite graft rejection associated with anti-MICA antibodies, early identification and prompt treatment can help preserve the graft function.