Severe haemolysis after an ABO unmatched kidney transplant - a nonsecretortransplanted from a donor with high anti-A titre

A case of severe haemolysis following an ABO unmatched renal transplant is reported in a group A nonsecretor who received a kidney from a group O livi ng related donor. Following the haemolytic episode, group A donor units wer e incompatible and the patient was transfused with group O blood. Serologic al investigation of the recipient revealed anti-A present in the serum and on the red cells. Investigation of the donor revealed the presence of high- titre anti-A. The association of such high-titre donor antibody with haemol ysis in ABO unmatched grafts has not been reported before. We discuss the r isk factors for developing haemolysis in an ABO unmatched organ transplant and explore the possible relevance of such high donor antibody titre to rec ipients who are nonsecretors.