INDUCTION OF RED BLOOD CELL DESTRUCTION BY GRAFT‐DERIVED ANTIBODIES AFTER MINOR ABO‐MISMATCHED HEART AND LUNG TRANSPLANTATION
INDUCTION OF RED BLOOD CELL DESTRUCTION BY GRAFT‐DERIVED ANTIBODIES AFTER MINOR ABO‐MISMATCHED HEART AND LUNG TRANSPLANTATION
复制标题
轻微 ABO 不匹配心肺移植后移植物衍生抗体诱导红细胞破坏
DOI：
10.1097/00007890-198808000-00012
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发表时间：
1988
期刊：
影响因子：
6.2
通讯作者：
Marcela Contreras
中科院分区：
文献类型：
--
作者：
B. Hunt;M. Yacoub;Sheela Amin;A. Devenish;Marcela Contreras
心肺移植（HLT）与其他实体器官移植不同，涉及大量淋巴组织的移植；因此，如果供体和受体之间存在抗原不匹配，则很可能发生移植物抗宿主反应。由于缺乏合适的捐赠者，需要进行轻微 ABO 不匹配的 HLT（将 O 型器官捐赠给 A、B 或 AB 受者）。在 Harefield 医院连续进行的 84 例 HLT 中，对 9 例 ABO 血型完全匹配的 HLT 和 9 例 ABO 不匹配的 HLT 进行了研究。六名轻微 ABO 不匹配的 HLT 患者有受者红细胞免疫破坏的证据。溶血从第4-12天开始，平均持续13天；有四种情况需要输血支持。在这些患者的血清和红细胞洗脱液中发现了与受体 ABO 抗原不相容但与供体相容的 ABO 抗体。在两个案例中，这些抗体在移植后一年多的时间内都被检测到。在完全 ABO 匹配的对照中没有看到这些变化。我们的研究结果表明，来自 O 组器官的供体来源的淋巴细胞在移植后继续产生抗 A 和/或抗 B，如果受体是 A、B 或 AB 组，则在受体不同 ABO 抗原的抗原刺激后会产生二次免疫反应。讨论了这些患者的具体输血管理。
Heart-lung transplantation (HLT) unlike other solid-organ transplants involves transplantation of a large amount of lymphoid tissue; hence there is considerable potential for graft-versus-host reaction if there is an antigen mismatch between donor and recipient. Due to the shortage of suitable donors, minor ABO-mismatched HLT (group O organs given to A, B, or AB recipients) are performed. Of 84 consecutive HLT at Harefield Hospital, nine fully ABO-matched and nine ABO-mismatched HLT were studied. Six minor ABO-mismatched HLT patients had evidence of immune destruction of recipient's red cells. Haemolysis started from days 4-12 and lasted for a mean of 13 days; in four cases transfusion support was necessary. ABO antibodies incompatible with the recipient ABO antigens, but compatible with the donor, were found in the serum and red cell eluates of these patients. In two cases, these antibodies were detected for over one year after transplantation. These changes were not seen in the fully ABO-matched controls. Our findings suggest that donor-derived lymphocytes from group O organs continue to produce anti-A and/or anti-B after transplantation, and if the recipient is group A, B, or AB, mount a secondary immune response following antigenic stimulation by the recipient's differing ABO antigens. The specific transfusion management of these patients is discussed.