Salerno C T, Burdine J, Perry E H, Kshettry V R, Hertz M I, Bolman R M
Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Transplantation. 1998 Jan 27;65(2):261-4. doi: 10.1097/00007890-199801270-00021.
Organ donors and transplant recipients are routinely tested for ABO compatibility. ABO-identical organs are preferred, but occasionally the use of an ABO-compatible but nonidentical donor is clinically warranted. In heart-lung transplantation, the incidence of hemolysis from donor-derived anti-ABO antibodies is as high as 70%. The incidence of hemolysis for lung-only transplantation is not known. Our current posttransplantation transfusion policy for ABO-compatible but nonidentical lung-only transplant recipients is, when indicated, to use donor ABO group red blood cells.
To evaluate the efficacy of our transfusion policy, we reviewed our experience from 1986-96. One heart-lung transplant, four single lung transplant, and three bilateral single lung transplant recipients received ABO-compatible but nonidentical organs.
The heart-lung transplant recipient developed a positive direct antiglobulin test (DAT), with anti-A eluted, and severe hemolysis on postoperative day 8 requiring plasma and whole blood exchange. Four of six lung-only transplant patients tested developed a positive DAT with anti-A eluted. Two early lung-only patients, who did not receive donor ABO group red blood cells, demonstrated clinical and laboratory evidence of hemolysis. Three bilateral lung transplant recipients were followed prospectively. The first patient had a negative DAT. The next two patients developed positive DATs on postoperative day 8 and 10, respectively. No evidence of hemolysis was detected in any of these cases.
These results confirm that donor-derived anti-ABO antibodies develop with lung-only transplants. Our current transfusion policy is justified for both heart-lung and lung recipients of ABO-compatible but nonidentical organs. A high index of suspicion for donor-derived antibody causing hemolysis and communication with blood bank personnel are mandatory in this setting.
器官捐献者和移植受者通常会进行ABO血型相容性检测。ABO血型相同的器官是首选，但在临床上有时也有必要使用ABO血型相容但不相同的供体。在心肺移植中，供体来源的抗ABO抗体导致溶血的发生率高达70%。单纯肺移植中溶血的发生率尚不清楚。我们目前对于ABO血型相容但不相同的单纯肺移植受者的移植后输血策略是，在有指征时使用供体ABO血型的红细胞。
为评估我们输血策略的效果，我们回顾了1986年至1996年的经验。1例心肺移植受者、4例单肺移植受者和3例双侧单肺移植受者接受了ABO血型相容但不相同的器官。
心肺移植受者术后第8天直接抗球蛋白试验（DAT）呈阳性，洗脱出血清抗A，出现严重溶血，需要进行血浆和全血置换。6例单纯肺移植患者中有4例检测DAT呈阳性，洗脱出血清抗A。2例早期单纯肺移植患者未接受供体ABO血型的红细胞，出现了溶血的临床和实验室证据。对3例双侧肺移植受者进行了前瞻性随访。第1例患者DAT阴性。接下来的2例患者分别在术后第8天和第10天DAT呈阳性。这些病例均未检测到溶血证据。
这些结果证实了单纯肺移植中会出现供体来源的抗ABO抗体。我们目前的输血策略对于ABO血型相容但不相同器官的心肺和肺移植受者都是合理的。在这种情况下，必须高度怀疑供体来源的抗体导致溶血，并与血库人员沟通。
