RED-CELL ALLOANTIBODY DEVELOPMENT ASSOCIATED WITH HEART AND LUNG TRANSPLANTATION

The development and persistence of clinically significant red cell all oantibodies were studied in 1132 patients who underwent a heart and/or lung transplant at Harefield Hospital. Clinically significant antibod ies were detected in 15 patients (1.3%) preoperatively and appeared in a further 15 (2.1%) of 704 patients followed up 1-404 weeks after sur gery. Anti-D developed in only 1 of 52 D-negative recipients of a D-po sitive donor graft and in only 2 of 6 D-negative patients who were tra nsfused with between 6 and 32 units of D-positive red cells. Most anti bodies that appeared after transplantation remained detectable for onl y a few weeks. Antibodies detected preoperatively that reacted only wi th papain-treated cells became persistently undetectable in 4 patients who were transfused with red cells expressing the corresponding antig en specificity. By contrast, antibodies detected preoperatively by ind irect antiglobulin test were still detectable after periods of up to 2 60 weeks in 4 patients who received only antigen-negative red cells. I mmunosuppressive therapy appeared to profoundly affect the natural his tory of red cell alloantibody production in these patients. The underl ying mechanisms warrant further study.