Bracey A W
Department of Pathology, University of Texas Medical School, Houston.
Vox Sang. 1987;53(3):181-3. doi: 10.1111/j.1423-0410.1987.tb04946.x.
The development of iso- and alloantibodies reactive with recipient red blood cells subsequent to organ transplantation is an established phenomenon. However, development of self-reactive antibodies in multiple recipients of organs from a single donor source has only been reported in one instance involving the formation of anti-D after transplantation. We observed the development of a delayed hemolytic transfusion reaction 10 days after transplantation of a group O liver into a group A recipient. Serologic studies revealed a positive direct antiglobulin test due to coating of autologous A cells with anti-A. Close follow-up of the group A recipients of the kidneys transplanted from the same group O donor revealed development of hemolysis secondary to anti-A on day 11 in one recipient and hemolysis due to anti-A on day 13 in a second recipient. Significant anemia, a 2-3 g/dl drop in hemoglobin, occurred in both kidney recipients. These findings suggest that recipient of organs from donors whose transferred lymphocytes have produced antirecipient RBC antibodies in another recipient may be at risk for developing a similar self-limited hemolytic episode and should be followed accordingly.
器官移植后产生与受者红细胞发生反应的同种抗体和自身抗体是一种已被证实的现象。然而，单一供体来源的多个器官受者体内出现自身反应性抗体的情况仅在1例移植后形成抗-D的报道中出现过。我们观察到，将O型肝脏移植给A型受者后10天出现了迟发性溶血性输血反应。血清学研究显示，由于自身A型细胞被抗-A包被，直接抗球蛋白试验呈阳性。对同一O型供体移植肾脏的A型受者进行密切随访发现，1名受者在第11天出现了继发于抗-A的溶血，另1名受者在第13天出现了抗-A所致的溶血。两名肾脏受者均出现了严重贫血，血红蛋白下降了2 - 3 g/dl。这些发现表明，接受来自供体的器官的受者，如果供体的淋巴细胞在另一名受者体内产生了抗受者红细胞抗体，那么该受者可能有发生类似自限性溶血发作的风险，应相应地进行随访。
