Fl. Ierino et al., Disseminated intravascular coagulation in association with the delayed rejection of pig-to-baboon renal xenografts, TRANSPLANT, 66(11), 1998, pp. 1439-1450
Background. Intravascular fibrin deposition and platelet sequestration occu
r with porcine xenograft rejection by baboons. Disseminated intravascular c
oagulopathy may arise either as a direct consequence of the failure to full
y deplete xenoreactive natural antibodies and block complement, or because
of putative cross-species molecular incompatibilities in this discordant sp
ecies combination.
Methods. Three baboons were conditioned with retrovirally transduced autolo
gous bone marrow to induce tolerance to swine antigens, Xenoreactive natura
l antibodies and complement were depleted by plasmapheresis and the use of
Gal alpha 1-3Gal column adsorptions; baboons were then splenectomized and u
nderwent renal xenografting from inbred, miniature pigs, Soluble complement
receptor type-1 with protocol immunosuppression (mycophenolate mofetil, 15
-deoxyspergualin, steroids, and cyclosporine) was administered.
Results. A bleeding diathesis was clinically evident from days 5 to 12 afte
r transplantation in two baboons, Low levels of circulating C3a, C3d, and i
C3b were measured despite the absence of functional circulating complement
components. Profound thrombocytopenia with abnormalities in keeping with di
sseminated intravascular coagulopathy were observed. Prolongation of prothr
ombin and partial thromboplastin times was accompanied by evidence for tiss
ue factor-mediated coagulation pathways, high levels of thrombin generation
(prothrombin fragment F1+2 production and thrombin-antithrombin complex fo
rmation), fibrinogen depletion, and production of high levels of the fibrin
degradation product D-dimer, Importantly, these disturbances resolved rapi
dly after the excision of the rejected xenografts in two surviving animals.
Histopathological examination of the rejected xenografts confirmed vascula
r injury, fibrin deposition, platelet deposition, and localized complement
activation,
Conclusions. Systemic coagulation disturbances are associated with delayed
xenograft rejection.