Bakr Mohamed A, Abbas Tarek M, Mustafa Amany, Ghoneim Mohamed A
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Clin Exp Nephrol. 2009 Apr;13(2):161-165. doi: 10.1007/s10157-008-0113-y. Epub 2009 Jan 20.
ABO compatible non-identical kidney transplants are used frequently. Acquired hemolytic anemia has been reported after ABO mismatched transplantation. Patients of A, B or AB blood groups may receive organs from ABO-compatible, but non-identical donors, mostly from O blood group donors. It may also occur in patients of the AB blood group who receive a kidney from a donor of the A or B blood groups.
ABO non-identical living donor kidney transplantation was done in 214 cases. All studied patients received kidneys from one haplotype HLA mismatched living donors and had pretransplant non-specific blood transfusions. There were 164 males and 50 females with a mean age of 30 years. Ten patients with cyclosporine (CsA)-based therapy developed hemolysis. CsA was stopped in patients maintained on triple immunosuppression (pred, CsA, AZA) and shifted to azathioprine in patients maintained on pred CsA therapy. In all patients pretransplant antibody screen, direct antiglobulin test (DAT) and cytotoxic cross match were all negative.
The prognosis was excellent in nine patients, and one died from severe hemolysis. Hemolytic anemia was more frequent among blood group A recipients (60% of our cases) and more severe among recipient blood group B. Six patients received antigen-negative packed RBCs. Univariate analysis demonstrated significant impact for recipient age, donor sex, number of pretransplant blood transfusions, primary immunosuppression, time to onset of diuresis, recipient and donor blood groups. Multivariate analysis restricted the significance to blood group of donor and recipient, time to onset of diuresis and primary immunosuppression.
Post transplant hemolysis is infrequent after renal transplantation; however, it may occur with compatible, non-identical ABO blood group donors. Blood group of donor and recipient, time to onset of diuresis and primary immunosuppression (mainly CsA) were significant risk factors in hemolytic anemia in patients after ABO non-identical living donor kidney transplantation. The condition is usually mild and self limited, and change of immunosuppression (stop CsA) can treat the condition.
ABO血型相容的非同基因肾移植被频繁应用。ABO血型不匹配移植后曾有获得性溶血性贫血的报道。A、B或AB血型的患者可接受来自ABO血型相容但非同基因供者的器官，大多数来自O血型供者。它也可能发生在接受A或B血型供者肾脏的AB血型患者中。
对214例患者进行了ABO血型非同基因活体供肾移植。所有研究患者均接受来自单倍型HLA不匹配活体供者的肾脏，并在移植前进行了非特异性输血。其中男性164例，女性50例，平均年龄30岁。10例接受基于环孢素（CsA）治疗的患者发生了溶血。维持三联免疫抑制（泼尼松、CsA、硫唑嘌呤）治疗的患者停用CsA，维持泼尼松和CsA治疗的患者改用硫唑嘌呤。所有患者移植前抗体筛查、直接抗球蛋白试验（DAT）和细胞毒性交叉配型均为阴性。
9例患者预后良好，但1例死于严重溶血。溶血性贫血在A型受者中更为常见（占我们病例的60%），在B型受者中更为严重。6例患者接受了抗原阴性的浓缩红细胞。单因素分析显示受者年龄、供者性别、移植前输血次数、初始免疫抑制、利尿开始时间、受者和供者血型有显著影响。多因素分析将显著性因素限定为供者和受者血型、利尿开始时间和初始免疫抑制。
肾移植后移植后溶血并不常见；然而，它可能发生在ABO血型相容但非同基因的供者中。供者和受者血型、利尿开始时间和初始免疫抑制（主要是CsA）是ABO血型非同基因活体供肾移植患者溶血性贫血的重要危险因素。这种情况通常较轻且具有自限性，改变免疫抑制（停用CsA）可治疗该疾病。
