title: Immunization by blood-type antigen in human immunoglobulin products before ABO-incompatible kidney transplantation.
abstract: A 29-year-old man wanted to receive an ABO-incompatible kidney transplant. His blood type was O, and the donor, his father, was A1. After endoscopic splenectomy performed before kidney transplantation, the recipient developed a high fever and leukocytosis, and he was treated with antibiotics and 5 g of human immunoglobulin products by intravenous infusion for 3 d. Soon after the infusions, his anti-blood type A antibody titer (anti-A titer) rose, and several sessions of plasma-exchange (PEX) and double-filtration plasmapheresis (DFPP) failed to lower it. Three courses of anti-CD20 monoclonal antibody were administered to suppress the antibody production more specifically, and the rituximab infusions and repeated PEX and DFPP session lowered the anti-A titer and enabled kidney transplantation. Mild humoral rejection was observed 16 d after transplantation, but the recipient's serum creatinine was 1.5 mg/dL when discharged from the hospital. The increased anti-A titer may have been due to immunization by blood-type A antigen, with the human immunoglobulin products given to the patient being the source of the antigen. Administration of human immunoglobulin products to recipients of ABO-incompatible kidney transplants should be avoided, because it may cause an unexpected increase in anti-blood-type antibody titer.
authors.affiliation: Second Department of Surgery, Dokkyo University School of Medicine, Mibu, Tochigi, Japan. tsawada@dokkyomed.ac.jp
authors.forename: Tokihiko
authors.initials: T
authors.lastname: Sawada
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ando
authors.forename: Sumihiko
authors.initials: S
authors.lastname: Sato
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
authors.forename: Shohei
authors.initials: S
authors.lastname: Fuchinoue
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teraoka
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001787:Blood Group Incompatibility / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007114:Immunization; D016756:Immunoglobulins, Intravenous / Q000276:immunology*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D010951:Plasma Exchange; D010956:Plasmapheresis; D000069283:Rituximab
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab