Hyma B A, Moore S B, Grande J P, Talmo J J, Reisner R K, Rakela J, Krom R A
Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota.
Transfusion. 1988 May-Jun;28(3):276-9. doi: 10.1046/j.1537-2995.1988.28388219160.x.
Immune hemolytic anemia in patients after organ transplantation has been reported generally to be graft-cell-derived due to elaboration by the donor's "passenger" lymphocytes of the antibodies directed against the recipient's red cell antigens. In contrast, this report presents a case that illustrates postoperative red cell alloantibody production by the recipient of an orthotopic liver transplant. Anti-Jka, -c, and -S, detected in the recipient's serum 9 days after transplantation, resulted in significant hemolysis. These alloantibodies had not been present in the recipient's serum before transplantation or in the sera of the liver or blood donors. In addition, anti-Jka and -c were eluted from posttransfusion red cells. The patient was transfused during surgery with crossmatch-compatible blood, that carried the alloantigens Jka, c, and S. The liver donor's red cells also carried the Jka, c, and S antigens. The recipient's pretransplantation red cell phenotyping was Jk(a-), c-, S-. The recipient had received only one transfusion 10 years prior to this operation, after which time he was noted to have anti-K. Immunosuppression initially consisted of cyclosporine, azathioprine, and prednisolone. This is believed to be the first report of delayed immune hemolysis due to non-ABO antibodies in a liver transplant patient treated with cyclosporine.
器官移植后患者发生的免疫性溶血性贫血一般据报道是移植物细胞来源的，这是由于供体的“过客”淋巴细胞产生针对受者红细胞抗原的抗体所致。相比之下，本报告介绍了一例原位肝移植受者术后产生红细胞同种抗体的病例。移植后9天在受者血清中检测到的抗Jka、-c和-S导致了显著的溶血。这些同种抗体在移植前受者血清中或肝或血液供者血清中均不存在。此外，抗Jka和-c从输血后红细胞上洗脱下来。患者在手术期间输注了与交叉配血相容的血液，该血液携带同种抗原Jka、c和S。肝供者的红细胞也携带Jka、c和S抗原。受者移植前红细胞表型为Jk(a-)、c-、S-。该受者在此次手术前10年仅接受过一次输血，此后发现其有抗-K。免疫抑制最初包括环孢素、硫唑嘌呤和泼尼松龙。据信这是关于接受环孢素治疗的肝移植患者因非ABO抗体导致迟发性免疫溶血的首例报告。
