The development of D antibodies after D-mismatched kidney transplantation in a setting of reduced immunosuppression

Thomas H. P. M. Habets, Joris Vanderlocht*, Ron J. M. H. E. Straat, Tim C. van Smaalen, Gerard M. J. Bos, Erik A. Beckers, Maarten H. L. Christiaans, Yvonne M. C. Henskens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUNDD antigens are not taken into account in the allocation of solid organs. Female transplant recipients with D antibodies as a consequence of D-mismatched kidney transplantation may develop hemolytic disease of the fetus and newborn in future pregnancies. We examined D antibody development in transplant recipients who received D-mismatched kidney transplantation in absence of D prophylaxis and in a setting of reduced immunosuppression. STUDY DESIGN AND METHODSFrom 1993 until 2015, a total of 1355 kidney patients received transplantations in our center of whom 156 received a D-mismatched graft. A retrospective analysis was conducted; frozen stored sera obtained from transplant recipients 3 months after transplantation were tested for irregular red blood cell (RBC) antibodies using a three-cell screening and an identification panel. In the case of D antibody positivity, additional testing was performed 1 month before transplantation. RESULTSIn seven of 156 (4.5%) transplant recipients we found irregular RBC antibodies after transplantation, of which five (3.2%) were determined to be D antibodies. We observed only one (0.6%) recipient without D antibodies before transplantation. CONCLUSIONAlthough the risk of D antibody development is considerably lower after D-mismatched kidney transplantation than D-mismatched pregnancy, anti-D prophylaxis may still be advisable for female transplant recipients of childbearing age.
Original languageEnglish
Pages (from-to)100-104
Number of pages5
JournalTransfusion
Volume58
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • RENAL-TRANSPLANTATION
  • HEMOLYTIC-DISEASE
  • RHD ANTIBODIES
  • IMMUNIZATION
  • PERSISTENCE
  • PREGNANCY
  • NEWBORN

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