PubMed · 12070879
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Lyle J Palmer, Audrey H Schnell, John S Witte, Robert C Elston. 2002. Parametric linkage analysis.. https://doi.org/10.1385/1-59259-176-0%3A013
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Despite the presence of preformed antibodies against AB oligosaccharide epitopes on the donor vascular endothelium, approximately one-third of ABO-incompatible organ allografts are not rejected by a humoral mechanism. With the growing immune-manipulation of the recipient, survival rates can be raised considerably, although they remain significantly inferior to those of ABO-compatible transplantation. Data from the Collaborative Transplant Study indicate a 1-year graft survival rate of approximately 50-60% following cadaveric ABO-incompatible kidney, liver or heart transplantation, compared with 70-80% for an ABO-compatible organ. The results for infants and young children, however, are very much better than those of adults, particularly for liver and heart transplantations, and the data suggest that B-cell tolerance can develop in the infant age group. We here review clinical and experimental experience with ABO-incompatible organ and bone marrow allotransplantation and address the mechanisms by which organs or cells survive in the presence of natural anti-carbohydrate antibodies.
UNLABELLED: The administration of anti-D globulin to the mothers has decreased the incidence of Rh hemolytic disease but the improvement of technologic assays has made it possible to identify several hemolytics diseases of the newborn. BACKGROUND: To identify the prevalence of immunohematologic tests demonstrated by indirect (IC), direct (DC) and elution tests; to identify the incidence of hemolytic disease and its treatment (phototherapy and/or exchange transfusion) in neonates with hemolytic disease. This is a retrospective cohort-study performed from January 1st 1996 to July 1st 1998. METHODS: This is a descriptive study of the immunohematologic profile of 1698 mothers and their offsprings, as risk factors for developing hemolytic disease. The inclusion criteria were the positivity of the indirect (IC) and direct (DC) Coombs tests and elution tests. Based on the inclusion criteria three group of infants were analyzed: Group I was composed of 149 offsprings of Coombs-positive mothers (IC+) with antibodies associated with neonatal hemolytic disease. This group was further divided into two groups: Group I-A (IC+DC+) was composed of 83 Coombs-positive offsprings (DC+) of Coombs-positive mothers (IC+) and Group I-B (IC+DC-) was composed of 66 Coombs-negative offsprings (DC-) of Coombs-positive mothers (IC+); Group D was composed of 736 Coombs-positive offspring's of Coombs-negative mothers (IC-); and Group E was composed of 807 Coombs-negative and elution-positive offspring's of Coombs-negative mothers. RESULTS: This study shown that the overall prevalence of immunohematologic tests associated with hemolytic disease was 9.07% (3212/35429), 0.43% (154/35429) among offsprings of Coombs-positive mothers, 4.10% (1453/35429) among Coombs-positive infants, and 4.53% (1605/35429) among elution-positive infants. The overall incidence of hemolytic disease was 36.23% (613/1692), 33.56% (50/149) among offspring's of Coombs-positive mothers, 44.43% (327/736) among Coombs-positive infants, and 29.24% (236/807) among elution-positive infants. The overall incidence of phototherapy among infants with hemolytic disease was 36.23% (613/1692), 49.40% (41/83) in group I-A (IC+DC+), 13.64% (9/66) in group I-B(IC+DC-), 44.43% (327/736) in group D, and 29.24% (236/807) in group E. The overall incidence of exchange transfusion among infants with hemolytic disease was 0.88% (15/1692), 14.46% (12/83) in group I-A (IC+DC+), 0% (0/66) in group I-B (IC+DC-), 0.27% (2/736) in group D, and 0.12% (1/807) in group E. CONCLUSIONS: The results of this study allowed us to conclude that the overall prevalence of immunohematologic tests associated with hemolytic disease was 9.07% (3212/35429) and the overall incidence of hemolytic disease was 36.23% (613/1692) in this study-group. The highest incidences of hemolytic disease and phototherapy were observed among Coombs-positive offsprings of Coombs-positive mothers.
BACKGROUND: Given the scarcity of cadaveric organs, efforts are intensifying to increase the availability of living donors. The current study assessed the feasibility of using ABO-incompatible living-donor kidneys to expand the donor pool. METHODS: The authors performed 18 ABO-incompatible living-donor kidney transplants between May 1999 and April 2001. Ten patients received living-donor kidneys from A2 and eight patients received kidneys from non-A2 blood group donors. Immunosuppression consisted of Thymoglobulin antibody induction, tacrolimus, mycophenolate mofetil, and prednisone. Eight non-A2 and two A2 kidney recipients also received a pretransplant conditioning regimen of four plasmapheresis treatments followed by intravenous immunoglobulin and splenectomy at the time of transplantation. Antidonor blood group antibody titer was measured at baseline, pretransplant, at 1- to 3-month and 1-year follow-up, and at the time of diagnosis of antibody-mediated rejection. RESULTS: No hyperacute rejection episodes occurred. One-year graft and patient survival rates in the 18 ABO-incompatible recipients were only slightly lower than those of 81 patients who received ABO-compatible kidney transplants during the same period (89% vs. 96% and 94% vs. 99%, respectively). Glomerular filtration rate and serum creatinine levels did not differ between the groups. Antibody-mediated rejection occurred in 28% of ABO-incompatible recipients, and was reversible with plasmapheresis, intravenous immunoglobulin, and increasing immunosuppression in all patients except one. CONCLUSIONS: ABO-incompatible living donor kidney transplants can achieve an acceptable 1-year graft survival rate using an immunosuppressive regimen consisting of Thymoglobulin induction, tacrolimus, mycophenolate mofetil, and prednisone combined with pretransplant plasmapheresis, intravenous immunoglobulin, and splenectomy.