Myser T, Steedman M, Hunt K, Strohm P, Williams M, Kennedy M
Hum Immunol. 1986 Oct;17(2):102-6. doi: 10.1016/0198-8859(86)90080-7.
A patient with aplastic anemia received an ABO incompatible bone marrow transplant (BMT) from an HLA identical sibling. Weekly HLA antibody screens were performed as part of the BMT protocol. At the time of transplant, a hemolytic anti-Le(a) was detected in the Le (a-b-) donor. The Le (a-b+) recipient had no red cell or LCT antibody. A hemolytic anti-Le(a) was detected in the recipient on day 8, but no LCT reactivity was noted at this time. On day 15, the LCT panel demonstrated reactivity with 9 of 50 panel cells without apparent HLA specificity. Graft vs. host disease (GVHD) was present on the skin at this time. The dose of cyclosporin A was increased, but by day 20 the GVHD worsened and the LCT titers increased to 8. This strong reactivity was noted only in the Le (a+) panel members (12/50) and was neutralized with commercial Lewis substance. On day 34 there was no evidence of GVHD, but the lymphocytotoxic anti-Lea continued to be present. The patient began experiencing renal and gastrointestinal difficulties by day 48, and expired on day 60. In renal transplants the kidneys retain their Lewis type and secrete Lewis substance in the urine. In our experience BMT patients retain their Lewis type regardless of the type of the donor. The Lewis system has been linked to renal allograft rejection, and Lewis antigens may function as transplantation antigens in BMT patients as well. In addition, lymphocytotoxic Lewis antibodies can mask other significant HLA antibodies and must be identified when screening patients in need of plateletpheresis products.
一名再生障碍性贫血患者接受了来自 HLA 相同同胞的 ABO 血型不相合骨髓移植（BMT）。作为 BMT 方案的一部分，每周进行 HLA 抗体筛查。移植时，在 Le（a - b -）供体中检测到溶血性抗 - Le(a)。Le（a - b +）受体没有红细胞或淋巴细胞毒抗体。移植后第 8 天在受体中检测到溶血性抗 - Le(a)，但此时未发现淋巴细胞毒反应性。第 15 天，淋巴细胞毒试验显示与 50 个细胞中的 9 个有反应，无明显 HLA 特异性。此时皮肤出现移植物抗宿主病（GVHD）。环孢素 A 剂量增加，但到第 20 天 GVHD 恶化，淋巴细胞毒滴度升至 8。仅在 Le（a +）细胞（12/50）中观察到这种强反应性，并用商业性 Lewis 物质中和。第 34 天无 GVHD 证据，但淋巴细胞毒抗 - Lea 持续存在。患者在第 48 天开始出现肾脏和胃肠道问题，并于第 60 天死亡。在肾移植中，肾脏保留其 Lewis 血型并在尿液中分泌 Lewis 物质。根据我们的经验，BMT 患者无论供体类型如何都保留其 Lewis 血型。Lewis 系统与肾移植排斥反应有关，Lewis 抗原在 BMT 患者中也可能作为移植抗原起作用。此外，淋巴细胞毒 Lewis 抗体可掩盖其他重要的 HLA 抗体，在筛查需要血小板单采制品的患者时必须加以识别。
