Solid organ transplantation across the ABO histo-blood group barrier: a case report

The ABO blood group system until recently constituted an insuperable barrier for solid organ transplantation, but cases of heart transplantation in infants and kidney transplantation in adults have been reported, wherein ABO-incompatible grafts have been successful. In 1990, the molecular genetic ba...

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Bibliographic Details
Published in:Transplantation proceedings 2004-06, Vol.36 (5), p.1554-1557
Main Authors: Nydegger, U.E, Rieben, R, Carrel, T, Mohacsi, P
Format: Article
Language:English
Subjects:
ABO Blood-Group System - immunology
Adult
Biological and medical sciences
Biopsy
Blood Group Incompatibility
Fatal Outcome
Heart Failure - blood
Heart Failure - immunology
Heart Failure - surgery
Heart Transplantation - immunology
Heart Transplantation - pathology
Humans
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Transplantation, Homologous
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Summary:The ABO blood group system until recently constituted an insuperable barrier for solid organ transplantation, but cases of heart transplantation in infants and kidney transplantation in adults have been reported, wherein ABO-incompatible grafts have been successful. In 1990, the molecular genetic basis of three major alleles at the ABO locus was elucidated; A and B glycosyltransferases are specified by a variety of functional alleles at this locus. The antibody response to ABH antigens, namely, naturally occurring anti-A/B IgM and IgG isotype agglutinins, are controlled preoperatively by recipient conditioning using plasma exchange, immunoadsorption, and immunosuppressive regimens. We report an O-type patient who accidentally received a B-type cardiac allograft in 1997 who survived for 5 years, dying for an unrelated reason. Over a period of 45 months semiquantitatively we monitored the expression of ABO-type antigens in graft heart vessels using monoclonal antibodies on sections of formalin-fixed, paraffin-embedded biopsies. We observed a progressive change in the antigenic profile of graft endothelial cells from B- to O-type, which was first detected at 1 year posttransplant and most prominent 3 years later, the end of the observation period. No temporal relationship was observed between the transition from B to O expression, the anti-B antibody levels or the immunosuppressive regimen.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2004.05.038