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• W2010255046 abstract "A 45-year-old man (blood group A1+, HLA A2/A2 B15/B51 DR12/DR15) with hepatitis B-related cirrhosis received an orthotopic liver transplant (OLT) from a male cadaveric donor (blood group O+, HLA A2/A11 B38/B46 DR8/DR14), with steroid, tacrolimus, and lamivudine coverage. Both parties were negative for atypical red blood cell antibodies. Six units of group A pack cells and 10 units each of group A platelets and group AB fresh-frozen plasma were transfused. At postoperative day 6, the hemoglobin (Hb) level was normal, and a steady fall in parenchymal enzymes and bilirubin indicated normal graft function. On day 8, the patient developed shock and jaundice, accompanied by a dramatic fall in Hb to 3 g/dL. The peripheral blood showed numerous spherocytes, with strongly positive direct antiglobulin test. Eight units of group O+ pack cells were transfused. Retrospective investigations showed high anti-A titers (Fig. 1; peak IgG 1:512, IgM 1:8) and high donor serum anti-A titers (IgG 1:2560, IgM 1:640). A peripheral blood chimerism study (day 11) showed no donor B or T lymphocyte DNA (1). Hemolysis persisted for 3 weeks, with peripheral film showing mixed field agglutination with reticulocytosis, and 4 more units of group O+ pack cells were given. Plasmapheresis or exchange transfusion was not performed in view of falling anti-A titers with no donor lymphocyte engraftment.Figure 1: Abbreviations used in figure: OLT, orthotopic liver transplantation; Ig, immunoglobulin titer; LDH, lactate dehydrogenase level; Hb, hemoglobin; bili, bilirubin.Most cases of OLT are not performed across ABO compatibility barrier. For ABO-compatible but mismatched OLT, ABO antibodies developed in 37% of cases, half of them with hemolysis, giving a 2 to 3 g/dL fall in Hb around day 7 (2), especially with group O donors (3). The operative use of donor group–specific blood may reduce ABO hemolysis, especially for high-titer donors (4). Our case of dramatic and sustained hemolysis illustrated the strength of the amnestic IgG production from passenger lymphocytes. Because the lymphocytes do not engraft and because they have a finite lifespan, the titers declined with hemolytic consumption and decreased production. In the unfortunate scenario of prolonged lymphocyte chimerism (e.g., shared HLA alleles), prolonged hemolysis can occur. This may be accompanied by graft-versus-host disease (1). Prudent monitoring of the peripheral blood and hemagglutinin titers will be needed to allow appropriate use of plasmapheresis or immunosuppression (5). Acknowledgments. The authors thank Dr. B. Hawkins for HLA typing results and Dr. K.F. Wong for donor anti-A titer levels. W. Y. Au1 2 C. M. Lo3 S. T. Fan3 C. L. Liu3 C. C. K. Lam4" @default.
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• W2010255046 date "2002-07-01" @default.
• W2010255046 modified "2023-09-25" @default.
• W2010255046 title "Life-threatening abo-mediated hemolysis after cadaveric orthotopic liver transplantation" @default.
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• W2010255046 doi "https://doi.org/10.1097/00007890-200207270-00024" @default.
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