03550nas a2200265   4500008004100000020001400041024001700055245006200072210006100134260008100195300001200276490000700288520269000295653003402985653004403019653003503063653002103098653004303119653001203162653001103174653002203185653001803207100001403225856004503239       1991                        eng d  a0041-1132  awdn, 041736000aRed cell antibodies arising from solid organ transplants.0 aRed cell antibodies arising from solid organ transplants  aUNITED STATESbRamsey,G. Central Blood Bank, Pittsburgh, Pennsylvania.c1991  a76 - 860 v313 aRBC antibodies arising from transplanted organs and directed against recipient RBCs represent a well-established immunohematologic complication of solid organ transplantation. In ABO-unmatched organs, the frequency and severity of graft antibodies and hemolysis generally increase with the size (lymphoid content) of the organ, from kidney to liver to heart-lung transplants. In the cases reviewed here, the frequency of hemolysis increased in cyclosporine-treated kidney transplant recipients and O-to-A liver transplant recipients and decreased in group AB liver transplant recipients and kidney transplant recipients receiving azathioprine or low-dose postoperative graft irradiation. Available data cannot otherwise distinguish which cyclosporine-treated recipients of ABO-unmatched kidneys and livers (30-40% of total) will develop graft antibody. There has been no conclusive effect to date of the age, race, or gender of the donor or the recipient, of cadaver versus living kidney donors, or of patients' A2 or secretor status. In a few cases of living-donor kidney grafts, the donor was the patient's mother or wife who had been exposed to the recipient's RBC antigens via pregnancy. The ABO antibodies are typically IgG, appear 7 to 10 days after transplantation, and last for about a month. If immediate-spin crossmatching is done routinely, DATs are recommended in compatibility testing after ABO-unmatched transplants. Changes in the immunosuppressive regimen, such as a change from cyclosporine therapy, have not affected the duration of these antibodies. Most patients require only transfusions for this self-limited process, but six cases of hemolysis-induced acute renal failure have been reported, and one death was attributed to complications of hemolysis. RBC or plasma exchange has been performed in a few fulminant cases. RBCs of the donor's blood type are given when antibody appears. Some workers recommend such transfusion as prophylaxis at the time of surgery, although in liver transplants, the plasma accompanying a large amount of group O RBCs given perioperatively might be problematic. In several other centers, ABO-unmatched liver transplants have equivalent overall graft survivals, but the Pittsburgh adult patients with hemolysis have had reduced early graft survival. In the cases reviewed here, nine IgG Rh antibodies from kidney grafts directed against recipient RBCs have been observed, usually beginning 2 to 3 weeks after a cyclosporine-treated transplant, lasting for 2 to 6 months after operation, and causing mild hemolysis. One case represented a primary immune response from a previously unsensitized donor.(ABSTRACT TRUNCATED AT 400 WORDS)10a*Erythrocytes/im [Immunology]10a*Graft vs Host Reaction/im [Immunology]10a*Isoantibodies/im [Immunology]10a*Transplantation10aABO Blood-Group System/im [Immunology]10aCadaver10aHumans10aImmunosuppression10aTissue Donors1 aRamsey, G  uhttps://notifylibrary.org/reference/4112