Successful unintentional ABO-incompatible renal transplantation: Blood group A1B donor into an A2B recipient.
OBJECTIVE
To report a successful unintentional transplantation of a deceased donor kidney from an "incompatible" A1B donor into a recipient who was blood group A2B with unsuspected preformed anti-A1 antibodies.


METHODS
The donor and recipient were both typed for ABO antigens. The recipient was tested for ABO and non-ABO antibodies. The recipient was typed for HLA class I and class II antigens, including HLA antibody screen. The T-and B-flow cytometry crossmatch test was performed using standard protocol.


RESULTS
The donor-recipient pair was a complete six-antigen human leukocyte antigen mismatch, but final T- and B-flow cytometry cross-match tests were compatible. The recipient was a 65-year-old woman with a medical history of end-stage renal disease secondary to diabetic nephropathy who underwent kidney transplantation from a 46-year-old brain-dead standard criteria donor. The recipient's RBCs were negative with A1 lectin, and the recipient was thus typed as an A2 subgroup. Anti-A1 could be demonstrated in the recipient's plasma. The donor's RBCs were positive with A1 lectin, thereby conferring an A1 blood type.


CONCLUSIONS
It is safe to transplant across the A1/A2 blood group barrier provided that the preformed antibodies are not reactive at 37°C and with anti-human globulin.
Dept of Pathology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157; efadeyi@wakehealth.edu.
Emmanuel A
EA
Fadeyi
Robert J
RJ
Stratta
Alan C
AC
Farney
Gregory J
GJ
Pomper
D000017:ABO Blood-Group System / Q000276:immunology*; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology*; D001926:Brain Death; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods; D008875:Middle Aged; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D006680:HLA Antigens
ABO incompatible; Antibody-mediated rejection; HLA mismatch; Immunology; Renal transplant; Special topics; Transfusion medicine