Pikul F J, Bolman R M, Saffitz J E, Chaplin H
Department of Pathology, Washington University School of Medicine, St Louis, MO.
Transplant Proc. 1987 Dec;19(6):4601-4.
A group A recipient received a group B cardiac allograft. Aggressive plasma exchange with replacement by group AB FFP initially reduced the recipient's anti-B titer to a low level. Once a secondary anti-B response was mounted, plasma exchange was ineffective and IgM and IgG anti-B titers rose to high levels. Associated with the increased anti-B titers, cardiac function deteriorated and on day 13 the group B heart was replaced by a group A allograft. The compatible allograft functioned well initially but was eventually rejected, and the patient died 51 days after the initial transplantation. Histologic examination of the first allograft revealed a delayed form of typical antibody-mediated rejection with destruction of the microvasculature associated with antibody deposition and acute inflammation. By contrast, the histopathology of the second compatible allograft was typical of cell-mediated allograft rejection. Extracts of myocardium from the incompatible heart contained IgM and IgG anti-B, while no anti-B alloantibody was demonstrable in the extracts of the ABO-compatible allograft and a control heart. The utility of plasma exchange with group AB FFP replacement in such a circumstance requires further study.
一名A组受者接受了B组心脏同种异体移植。最初，通过用AB组新鲜冰冻血浆进行积极的血浆置换，将受者的抗B滴度降低到了较低水平。一旦出现二次抗B反应，血浆置换就无效了，IgM和IgG抗B滴度升至高水平。随着抗B滴度的升高，心脏功能恶化，在第13天，B组心脏被A组同种异体移植心脏所取代。相容性同种异体移植心脏最初功能良好，但最终被排斥，患者在初次移植后51天死亡。对第一个同种异体移植心脏的组织学检查显示为典型的抗体介导的迟发性排斥反应，伴有与抗体沉积和急性炎症相关的微血管破坏。相比之下，第二个相容性同种异体移植心脏的组织病理学是典型的细胞介导的同种异体移植排斥反应。不相容心脏的心肌提取物含有IgM和IgG抗B，而在ABO相容性同种异体移植心脏和对照心脏的提取物中未检测到抗B同种异体抗体。在这种情况下，用AB组新鲜冰冻血浆进行血浆置换的效用需要进一步研究。
