Antibody‐mediated hemolytic anemia following ABO‐mismatched organ transplantation: contributory role of HLA matching and polyclonal antilymphocyte globulin

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Abstract
We report three instances of antibody‐mediated hemolytic ancmia following ABO‐mismatched, but compatible, renal (n=2) and simultaneous pancreas‐kidney (n=1) transplantation. The two renal allograft recipients had received a 6‐antigen matched transplant; one received polyclonal antilymphocyte globulin to treat an early rejection episode. The simultaneous pancreas‐kidney transplant received polyclonal antilymphocyte globulin (ALG) as part of a quadruple therapy induction regimen. All three patients developed severe, but self‐limited, antibody‐mediated hemolytic anemia within two weeks of their transplants. Serologic testing demonstrated the hemolysis to be antibody mediated; furthermore, testing of the ALG lots demonstrated high titers of anti‐red blood cell antibodies. The possible contribution of ALG and HLA matching to the hemolysis seen in these patients after ABO mismatched organ transplantation is discussed.