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Am J Clin Pathol. 2014 May;141(5):724-6. doi: 10.1309/AJCPBGW81HQWBOZO.

Successful unintentional ABO-incompatible renal transplantation: Blood group A1B donor into an A2B recipient.

Author information

  • 1Dept of Pathology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157; efadeyi@wakehealth.edu.

Abstract

OBJECTIVES:

To report a successful unintentional transplantation of a deceased donor kidney from an "incompatible" A1B donor into a recipient who was blood group A2B with unsuspected preformed anti-A1 antibodies.

METHODS:

The donor and recipient were both typed for ABO antigens. The recipient was tested for ABO and non-ABO antibodies. The recipient was typed for HLA class I and class II antigens, including HLA antibody screen. The T-and B-flow cytometry crossmatch test was performed using standard protocol.

RESULTS:

The donor-recipient pair was a complete six-antigen human leukocyte antigen mismatch, but final T- and B-flow cytometry cross-match tests were compatible. The recipient was a 65-year-old woman with a medical history of end-stage renal disease secondary to diabetic nephropathy who underwent kidney transplantation from a 46-year-old brain-dead standard criteria donor. The recipient's RBCs were negative with A1 lectin, and the recipient was thus typed as an A2 subgroup. Anti-A1 could be demonstrated in the recipient's plasma. The donor's RBCs were positive with A1 lectin, thereby conferring an A1 blood type.

CONCLUSIONS:

It is safe to transplant across the A1/A2 blood group barrier provided that the preformed antibodies are not reactive at 37°C and with anti-human globulin.

KEYWORDS:

ABO incompatible; Antibody-mediated rejection; HLA mismatch; Immunology; Renal transplant; Special topics; Transfusion medicine

PMID:
24713746
[PubMed - indexed for MEDLINE]
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