Implications of ABO error rates in proficiency testing for solid organ transplantation
Implications of ABO error rates in proficiency testing for solid organ transplantation
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DOI：
10.1097/01.tp.0000230311.91869.75
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发表时间：
2006-09-27
期刊：
影响因子：
6.2
通讯作者：
Susskind, Brian M.
中科院分区：
文献类型：
--
作者：
Bryan, Christopher F.;Polesky, Herbert;Susskind, Brian M.
ABO是实体器官移植中重要的组织相容性屏障。经典的ABO血型屏障由A、B和O型患者中天然存在的同种凝集素定义。这些抗体分别针对血型抗原B、A和A和B，它们位于移植器官的血管内皮上。如果不进行降低同种凝集素水平的治疗，ABO血型不合的移植通常会导致器官的超急性或加速急性排斥反应（1-3），这是由于抗体与移植物血管内皮上的血型抗原结合、补体结合，最终导致移植物血栓形成。2003年，一名患者因接受ABO血型不合的心脏/肺移植并发症而死亡，媒体引起了全国的关注。器官共享联合网络（United Network for Organ Sharing，UNOS）的回应是，当任何患者被添加到等待名单时，他们必须进行两次ABO血型定型，两个人必须分别将患者的结果输入UNOS计算机（UNOS政策3.1）。4.2，www. unos。org）。联合国器官共享系统还规定，器官移植的已故捐赠者必须进行两次血型鉴定，并由两个人将其血型输入联合国器官共享系统（联合国器官共享系统政策5.0）。这些变化是有必要的，但在那时和自那时以来，没有ABO差异数据已发表，因此无法评估ABO分型错误的相对风险。
ABO poses an important histocompatibility barrier in solid organ transplantation. The classical ABO blood group barrier is defined by isoagglutinins that are naturally present in A, B, and O patients. The antibodies are directed respectively, to the blood group antigens, B, A, and A and B, which are located on the vascular endothelium of the transplanted organ. Without therapy to lower the isoagglutinin levels, ABO incompatible transplantation usually results in hyperacute or accelerated acute rejection of the organ (1–3) as the result of antibody binding to the blood group antigen on the graft vascular endothelium, complement fixation, and, ultimately, graft thrombosis. Such an event was brought to national attention by the media in 2003 when a patient died due to complications of receiving an ABO-incompatible heart/lung transplant. The United Network for Organ Sharing (UNOS) responded by mandating that when any patient was added to the waiting list they must be ABO typed two times and two people must separately enter the patient’s results into the UNOS computer (UNOS Policy 3.1. 4.2, www. unos. org). UNOS also mandated that deceased donors from whom organs are transplanted must be typed twice and their blood type entered into the UNOS system by two individuals (UNOS Policy 5.0). Those changes were warranted, but at and since that time, no ABO discrepancy data have been published so the relative risk of ABO typing errors cannot be assessed.