Lee J H, Mintz P D
Department of Pathology, University of Virginia Health Sciences Center, Charlottesville.
Am J Hematol. 1993 Nov;44(3):168-71. doi: 10.1002/ajh.2830440306.
Hemolysis caused by ABO antibodies after ABO-compatible, nonidentical solid organ transplantation has been previously reported. The passenger B lymphocytes within the donor organ presumably generate an acute, primarily red cell-directed graft vs. host (GVH) response. Graft survival may also be compromised. GVH Rh antibodies have also been described, primarily in renal transplants. Only three cases, two only in abstract form, have been reported thus far describing GVH Rh antibodies in liver transplant patients, to which we add a fourth. A 62-year-old blood group A Rho(D)-positive woman with cirrhosis underwent orthotopic liver transplantation from a group A Rho(D)-negative, previously Rho(D)-sensitized donor and subsequently developed acute, self-limited hemolysis requiring four units of packed red cells. Anti-Rho(D) was identified in both serum and red cell eluate. An antibody detection test, identification, and assessment of the antibody reactivity score from the pretransplant donor specimen may identify patients at risk for hemolysis due to GVH Rh antibodies.
此前已有报道称，在ABO血型匹配但不相同的实体器官移植后，ABO抗体可导致溶血。供体器官内的过客B淋巴细胞可能会引发一种急性的、主要针对红细胞的移植物抗宿主（GVH）反应。移植物存活也可能受到影响。也有关于GVH Rh抗体的描述，主要见于肾移植。迄今为止，仅有三例报告描述了肝移植患者中的GVH Rh抗体，其中两例仅以摘要形式发表，我们在此补充第四例。一名62岁的A血型、Rho（D）阳性且患有肝硬化的女性接受了来自一名A血型、Rho（D）阴性且既往对Rho（D）致敏的供体的原位肝移植，随后出现急性、自限性溶血，需要输注四个单位的浓缩红细胞。在血清和红细胞洗脱液中均检测到了抗Rho（D）抗体。通过对移植前供体标本进行抗体检测、鉴定以及评估抗体反应性评分，可能会识别出有因GVH Rh抗体导致溶血风险的患者。
