[Hemolytic anemia caused by graft-versus-host reaction in ABO-nonidentical renal transplants from blood group O donors].
Acute hemolytic anemia is one of the side effects associated with cyclosporin and tacrolimus therapy, and three mechanisms have been described to account for hemolytic anemia in patients receiving these drugs: drug induced hemolysis, autoimmune hemolysis and alloimmune hemolysis resulting from donor lymphocytes derived from the allograft (passenger lymphocyte syndrome). We report four cases of renal transplant recipients who developed alloimmune hemolytic anemia due to minor ABO incompatibility while under treatment with cyclosporin (two) and tacrolimus (two). The anti-erythrocyte antibodies responsible for hemolysis were of the IgG isotype and showed anti-A or anti-B specificity. These findings suggest that the hemolysis could be related to alloantibodies derived from the clonal development of donor B lymphocytes in the recipients (microchimerism). In summary, hemolytic anemia due to ABO-minor incompatibility occurs infrequently after renal transplantation. Risks are higher for patients A, B or AB blood group receiving an O blood group graft under treatment with cyclosporin or tacrolimus. Follow-up of these patients is warranted for the early detection and optimal management may be achieved by reduction of immunosuppression and change to mycophenolate mofetil.
Peces
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Servicio de Nefrología, Hospital Central de Asturias, Oviedo. rpeces@hulp.insalud.es
Díaz Corte
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D000017:ABO Blood-Group System / Q000276:immunology*; D000208:Acute Disease; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000276:immunology; D000918:Antibody Specificity; D016175:B-Lymphocyte Subsets / Q000276:immunology / Q000637:transplantation; D001787:Blood Group Incompatibility / Q000150:complications*; D002999:Clone Cells / Q000276:immunology; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D017809:Fatal Outcome; D006087:Graft vs Host Reaction / Q000276:immunology*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007518:Isoantibodies / Q000276:immunology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009395:Nephritis, Interstitial / Q000601:surgery; D009400:Nephrosclerosis / Q000601:surgery; D010531:Peritoneal Dialysis, Continuous Ambulatory; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000276:immunology; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use; D014019:Tissue Donors
D000017:ABO Blood-Group System; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016179:Granulocyte Colony-Stimulating Factor; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone