Red cell antigens and renal transplantation.
Donor-specific transfusion was performed with and without cyclosporine between haplomismatched relatives prior to living-donor renal transplantation. Red cell antigen mismatching was not taken as a contraindication to DST. Of 80 patients included in the trial; eleven were ABO-mismatched, 15 were Rh(D)-mismatched, and a further 11 were transfused in the presence of atypical red cell antibodies (anti-D, -C, -Fya, -Kell -N, -H/I -I, -P1, -Wra). Patients were randomized to receive cyclosporine (10 mg/kg) daily during DST or not (control group). The presence of atypical red cell antibodies, with the exception of Rh anti-D, did not appear to influence DST or renal transplantation. DST did not act as a primary stimulus to Rh anti-D production but stimulated preexisting anti D levels. ABO mismatching did not appear to influence DST or subsequent renal transplantation except in one group A [corrected] patient who received group O [corrected] blood and cyclosporine. This patient developed a severe, but self-limiting, autoimmune hemolytic anemia due to auto-anti A antibodies. A similar group A patient in the control group developed an auto-antibody with no clinical sequelae. The influence of cyclosporine on the development of this auto-antibody is uncertain. We conclude that, with the exception of preexisting anti-D antibodies, minor red cell antigen disparities should not preclude pretransplant conditioning with donor-specific transfusions.
Duguid
J K
JK
Mersey Regional Transfusion Centre, Liverpool, United Kingdom.
Hillis
A N
AN
Bone
J M
JM
D000017:ABO Blood-Group System; D001789:Blood Group Antigens; D001787:Blood Group Incompatibility; D003524:Cyclosporins / Q000627:therapeutic use; D004912:Erythrocytes / Q000276:immunology; D006801:Humans; D007114:Immunization; D016030:Kidney Transplantation / Q000276:immunology*; D016032:Randomized Controlled Trials as Topic; D012204:Rh-Hr Blood-Group System
D000017:ABO Blood-Group System; D001789:Blood Group Antigens; D003524:Cyclosporins; D012204:Rh-Hr Blood-Group System