ANTIBODY-MEDIATED HEMOLYTIC-ANEMIA FOLLOWING ABO-MISMATCHED ORGAN-TRANSPLANTATION - CONTRIBUTORY ROLE OF HLA MATCHING AND POLYCLONAL ANTILYMPHOCYTE GLOBULIN

We report three instances of antibody-mediated hemolytic anemia follow ing ABO-mismatched, but compatible, renal (n=2) and simultaneous pancr eas-kidney (n=1) transplantation. The two renal allograft recipients h ad received a 6-antigen matched transplant; one received polyclonal an tilymphocyte globulin to treat an early rejection episode. The simulta neous pancreas-kidney transplant received polyclonal antilymphocyte gl obulin (ALG) as part of a quadruple therapy induction regimen. All thr ee patients developed severe, but self-limited, antibody-mediated hemo lytic anemia within two weeks of their transplants. Serologic testing demonstrated the hemolysis to be antibody mediated; furthermore, testi ng of the ALG lots demonstrated high titers of anti-red blood cell ant ibodies. The possible contribution of ALG and HLA matching to the hemo lysis seen in these patients after ABO mismatched organ transplantatio n is discussed.