title: Massive immune hemolysis caused by anti-D after dual kidney transplantation.
abstract: Massive immune hemolysis due to passenger lymphocyte-derived anti-D has not been reported in renal transplantation. A 50-year-old (B-positive) male received a dual deceased-donor kidney transplant (B-negative) for diabetic renal failure. Two weeks post-transplant, the patient developed severe hemolytic anemia. The donor anti-D titer was 1:8. The recipient anti-D titer (zero pre-transplant) increased from 1:4 to 1:16 over 4 days. Rapid hemolysis caused severe anemia, minimum Hb = 4.2 g/dL, while selectively lysing the patient's autologous red cells during this time. The hemolytic anemia did not impair the allografts and subsided without monoclonal B-cell pharmacotherapy or apheresis. The anti-D titer decreased to barely detectable levels at four months and had cleared when checked 2 years post-transplant. Transfusion support subsided after two months. If complications of anemia can be avoided, the deleterious effects of hemolysis may be well tolerated by renal allografts using antigen negative transfusion alone.
authors.affiliation: Department of Pathology, Wake Forest University School of Medicine and North Carolina Baptist Hospital, Winston-Salem, NC, USA. gpomper@wfubmc.edu
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Pomper
authors.forename: Rita A
authors.initials: RA
authors.lastname: Joseph
authors.forename: Erica L
authors.initials: EL
authors.lastname: Hartmann
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rohr
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Adams
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
mesh_terms: D000017:ABO Blood-Group System; D000743:Anemia, Hemolytic / Q000175:diagnosis* / Q000209:etiology* / Q000276:immunology; D001787:Blood Group Incompatibility; D001788:Blood Grouping and Crossmatching; D003928:Diabetic Nephropathies / Q000473:pathology* / Q000628:therapy; D004912:Erythrocytes / Q000166:cytology* / Q000473:pathology; D006030:Glycosuria, Renal / Q000628:therapy; D006461:Hemolysis; D006801:Humans; D007518:Isoantibodies / Q000276:immunology* / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018029:Rho(D) Immune Globulin; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin