Hunt B J, Yacoub M, Amin S, Devenish A, Contreras M
North London Blood Transfusion Centre, Middlesex, United Kingdom.
Transplantation. 1988 Aug;46(2):246-9. doi: 10.1097/00007890-198808000-00012.
Heart-lung transplantation (HLT) unlike other solid-organ transplants involves transplantation of a large amount of lymphoid tissue; hence there is considerable potential for graft-versus-host reaction if there is an antigen mismatch between donor and recipient. Due to the shortage of suitable donors, minor ABO-mismatched HLT (group O organs given to A, B, or AB recipients) are performed. Of 84 consecutive HLT at Harefield Hospital, nine fully ABO-matched and nine ABO-mismatched HLT were studied. Six minor ABO-mismatched HLT patients had evidence of immune destruction of recipient's red cells. Haemolysis started from days 4-12 and lasted for a mean of 13 days; in four cases transfusion support was necessary. ABO antibodies incompatible with the recipient ABO antigens, but compatible with the donor, were found in the serum and red cell eluates of these patients. In two cases, these antibodies were detected for over one year after transplantation. These changes were not seen in the fully ABO-matched controls. Our findings suggest that donor-derived lymphocytes from group O organs continue to produce anti-A and/or anti-B after transplantation, and if the recipient is group A, B, or AB, mount a secondary immune response following antigenic stimulation by the recipient's differing ABO antigens. The specific transfusion management of these patients is discussed.
与其他实体器官移植不同，心肺移植（HLT）涉及大量淋巴组织的移植；因此，如果供体和受体之间存在抗原不匹配，就有相当大的移植物抗宿主反应的可能性。由于合适供体的短缺，进行了次要ABO血型不匹配的心肺移植（将O型器官给予A、B或AB型受体）。在哈雷菲尔德医院连续进行的84例心肺移植中，研究了9例完全ABO血型匹配和9例ABO血型不匹配的心肺移植。6例次要ABO血型不匹配的心肺移植患者有受体红细胞免疫破坏的证据。溶血从第4 - 12天开始，平均持续13天；4例患者需要输血支持。在这些患者的血清和红细胞洗脱液中发现了与受体ABO抗原不相容但与供体相容的ABO抗体。在2例患者中，移植后一年多仍能检测到这些抗体。在完全ABO血型匹配的对照组中未观察到这些变化。我们的研究结果表明，来自O型器官的供体淋巴细胞在移植后继续产生抗A和/或抗B抗体，如果受体是A、B或AB型，在受体不同的ABO抗原进行抗原刺激后会引发二次免疫反应。本文讨论了这些患者的具体输血管理。
