Donor-derived alloantibodies and passenger lymphocyte syndrome in two of four patients who received different organs from the same donor.
BACKGROUND
Reported here is the occurrence of RBC alloimmunization in two of four patients who received different organs from an immunized donor.


METHODS
The donor, a 58-year-old woman, was group O D+, K-, and Fy(a-). Initially, her serum contained only a K antibody. After blood transfusion, a second antibody (anti-Fy(a)) could also be identified. The liver was given to a group O D+, K-, Fy(a+) patient; the pancreas and one kidney to a group O D+, K-, Fy(a+) patient; the heart to a group A D+, K-, Fy(a-) patient; and the other kidney to a group B D+, K-, Fy(a+) patient. RBC grouping and antibody screening were performed by standard techniques. Lymphoid microchimerism in the peripheral blood of the recipients was analyzed by flow cytometry and nested PCR.


RESULTS
None of the recipients had irregular RBC alloantibodies at the time of transplantation. After the transplant, anti-K became detectable in the serum of the liver recipient, and anti-Fy(a) could be eluted from the RBCs of the liver recipient and the pancreas-kidney recipient. The latter patient also developed mild hemolysis, and his Hb dropped to 8 g per dL on posttransplant Day 9. Donor-derived lymphocytes were detectable by flow cytometry in the peripheral blood of the liver recipient and the pancreas-kidney recipient until Days 8 and 63, respectively, whereas no lymphoid chimerism could be demonstrated in the heart recipient. PCR chimerism analyses were positive in all three recipients over the whole observation period of 97 postoperative days.


CONCLUSIONS
The amount of cotransplanted lymphoid tissue may correlate with the extent of peripheral lymphoid microchimerism and the antibody-formation capacity in solid organ transplantation.
Bloodbank and Division of Hematology/Oncology, Department of Internal Medicine, Charité University Hospital/Virchow Clinic, Humboldt University Berlin, Berlin, Germany.
A
A
Seltsam
A
A
Hell
G
G
Heymann
A
A
Salama
D000328:Adult; D000937:Antigen-Antibody Reactions; D001782:Blood Donors; D002678:Chimera; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D015796:HLA-B27 Antigen / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D007518:Isoantibodies / Q000032:analysis*; D008214:Lymphocytes / Q000276:immunology*; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction / Q000379:methods; D014019:Tissue Donors
D015796:HLA-B27 Antigen; D007518:Isoantibodies