Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
H&I Department, Scottish National Blood Transfusion Service, Edinburgh, UK.
Am J Transplant. 2017 Aug;17(8):2207-2211. doi: 10.1111/ajt.14231. Epub 2017 Mar 17.
It is recognized that patients may become sensitized to donor-specific HLA antigens as a result of previous antigenic exposures, classically through previous transplantation, pregnancy, or blood transfusion. We present an unusual case of a patient who unexpectedly developed a range of anti-HLA antibodies following orthopedic surgery where a bone graft was deployed intraoperatively. We describe the case of a 52-year-old man awaiting a renal transplantation, undergoing elective orthopedic surgery requiring a small-volume bone graft. His postoperative antibody profile was found to be substantially changed compared to his previous negative samples, with the presence of HLA-DR, DQ, and DP specificities, at levels that would be likely to give a positive flow cytometry crossmatch and therefore according to local procedures required listing as unacceptable antigens for organ allocation. We perform a literature review of all previous cases of allosensitization following bone graft. This case is the first to demonstrate allosensitization following minor surgery with ;low-volume bone graft. Previous evidence is very limited and pertains only to massive osteochondral surgery for trauma or malignancy, and is confounded by potential concomitant blood transfusion. Clinicians should be aware of the risk of allosensitization where bone grafts are used.
人们认识到，患者可能由于先前的抗原暴露而对供体特异性 HLA 抗原产生致敏，经典的途径是先前的移植、妊娠或输血。我们报告了一个不寻常的病例，一名患者在骨科手术中使用了骨移植物，术后出乎意料地产生了一系列抗 HLA 抗体。我们描述了一名 52 岁男性的病例，他正在等待肾移植，接受需要小体积骨移植物的择期骨科手术。与他之前的阴性样本相比，他的术后抗体谱发生了显著变化，存在 HLA-DR、DQ 和 DP 特异性，其水平可能导致流式细胞交叉配型阳性，因此根据当地程序，需要将其列为器官分配不可接受的抗原。我们对所有先前的骨移植后同种致敏病例进行了文献复习。这是首例在小手术和小体积骨移植物后发生同种致敏的病例。先前的证据非常有限，仅涉及创伤或恶性肿瘤的大体积骨软骨手术，并且受到潜在的同时输血的影响。临床医生应意识到在使用骨移植物时发生同种致敏的风险。
