Antibody-mediated hemolytic anemia following ABO-mismatched organ transplantation: contributory role of HLA matching and polyclonal antilymphocyte globulin.
We report three instances of antibody-mediated hemolytic anemia following ABO-mismatched, but compatible, renal (n = 2) and simultaneous pancreas-kidney (n = 1) transplantation. The two renal allograft recipients had received a 6-antigen matched transplant; one received polyclonal antilymphocyte globulin to treat an early rejection episode. The simultaneous pancreas-kidney transplant received polyclonal antilymphocyte globulin (ALG) as part of a quadruple therapy induction regimen. All three patients developed severe, but self-limited, antibody-mediated hemolytic anemia within two weeks of their transplants. Serologic testing demonstrated the hemolysis to be antibody mediated; furthermore, testing of the ALG lots demonstrated high titers of anti-red blood cell antibodies. The possible contribution of ALG and HLA matching to the hemolysis seen in these patients after ABO mismatched organ transplantation is discussed.
Fabrega
A J
AJ
Department of Surgery/Division of Transplantation, University of Illinois, Chicago Medical Center, USA.
DeChristopher
J
J
Sosler
S D
SD
Rivas
P A
PA
Vasquez
E M
EM
Pollak
R
R
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000743:Anemia, Hemolytic / Q000097:blood / Q000276:immunology*; D000918:Antibody Specificity; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000276:immunology*; D004912:Erythrocytes / Q000276:immunology; D006084:Graft Rejection / Q000628:therapy; D006680:HLA Antigens / Q000276:immunology*; D006461:Hemolysis / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D016035:Pancreas Transplantation / Q000276:immunology*; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007518:Isoantibodies