Ramsey G, Hahn L F, Cornell F W, Boczkowski D J, Staschak S, Clark R, Hardesty R L, Griffith B P, Starzl T E
Central Blood Bank, University of Pittsburgh School of Medicine, Pennsylvania 15219.
Transplantation. 1989 Jun;47(6):993-5. doi: 10.1097/00007890-198906000-00015.
Transfusion of one unit or more of Rh-positive red blood cells normally causes circulating anti-D antibody to appear 2-6 months later in 80-95% of Rh- persons. We asked whether transplant immunosuppression with cyclosporine and corticosteroids affects Rh immunization. Nineteen Rh- liver, heart, and heart-lung transplant recipients received 3-153 (median: 10) units of Rh+ RBCs at surgery and were tested for anti-D greater than 2 months later. Three patients developed anti-D at 11-15 days; one may have had an unusually rapid primary immune response and two were secondary to previous exposure by pregnancy. None of the other 16 patients had anti-D when tested 2.5-51 months later (13 patients, greater than 11.5 months). This low rate of Rhesus immunization in association with cyclosporine immunosuppression allows greater flexibility in meeting the transfusion needs of Rh- liver and heart transplant patients. Caution is still advised in young females and in patients who may have been previously exposed to Rh+ RBCs by transfusion or by pregnancy prior to the availability of perinatal Rh immune globulin twenty years ago. Other humoral immune responses to some vaccines or infectious agents may also be impaired in transplant patients.
通常情况下，给 Rh 阴性个体输注一个单位或更多单位的 Rh 阳性红细胞，80% - 95%的人会在 2 - 6 个月后出现循环抗 D 抗体。我们研究了使用环孢素和皮质类固醇进行移植免疫抑制是否会影响 Rh 免疫。19 名 Rh 阴性肝、心脏和心肺移植受者在手术时接受了 3 - 153（中位数：10）单位的 Rh 阳性红细胞，并在 2 个月后检测抗 D 抗体。3 名患者在 11 - 15 天出现抗 D 抗体；其中 1 名可能有异常快速的初次免疫反应，另外 2 名继发于既往妊娠暴露。在 2.5 - 51 个月后检测时，其他 16 名患者（13 名患者检测时间超过 11.5 个月）均未出现抗 D 抗体。与环孢素免疫抑制相关的这种低 Rh 免疫发生率，使得在满足 Rh 阴性肝和心脏移植患者输血需求方面具有更大的灵活性。对于年轻女性以及在二十年前围产期 Rh 免疫球蛋白可用之前可能因输血或妊娠而接触过 Rh 阳性红细胞的患者，仍建议谨慎行事。移植患者对某些疫苗或感染因子的其他体液免疫反应也可能受损。
