Immunization by blood-type antigen in human immunoglobulin products before ABO-incompatible kidney transplantation

Clin Transplant. 2004 Apr;18(2):219-21. doi: 10.1046/j.1399-0012.2003.00144.x.

Abstract

A 29-year-old man wanted to receive an ABO-incompatible kidney transplant. His blood type was O, and the donor, his father, was A1. After endoscopic splenectomy performed before kidney transplantation, the recipient developed a high fever and leukocytosis, and he was treated with antibiotics and 5 g of human immunoglobulin products by intravenous infusion for 3 d. Soon after the infusions, his anti-blood type A antibody titer (anti-A titer) rose, and several sessions of plasma-exchange (PEX) and double-filtration plasmapheresis (DFPP) failed to lower it. Three courses of anti-CD20 monoclonal antibody were administered to suppress the antibody production more specifically, and the rituximab infusions and repeated PEX and DFPP session lowered the anti-A titer and enabled kidney transplantation. Mild humoral rejection was observed 16 d after transplantation, but the recipient's serum creatinine was 1.5 mg/dL when discharged from the hospital. The increased anti-A titer may have been due to immunization by blood-type A antigen, with the human immunoglobulin products given to the patient being the source of the antigen. Administration of human immunoglobulin products to recipients of ABO-incompatible kidney transplants should be avoided, because it may cause an unexpected increase in anti-blood-type antibody titer.

Publication types

  • Case Reports

MeSH terms

  • ABO Blood-Group System*
  • Adult
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Murine-Derived
  • Blood Group Incompatibility / immunology*
  • Blood Group Incompatibility / therapy
  • Humans
  • Immunization
  • Immunoglobulins, Intravenous / immunology*
  • Kidney Transplantation*
  • Living Donors*
  • Male
  • Plasma Exchange
  • Plasmapheresis
  • Rituximab

Substances

  • ABO Blood-Group System
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Immunoglobulins, Intravenous
  • Rituximab