Low Rate of Rhesus Immunization From Rh-Incompatible Blood Transfusions During Liver and Heart Transplant Surgery

Abstract

Transfusion of one unit or more of Rh-positive red blood cells normally causes circulating anti-D antibody to appear 2-6 months later in 80-95% of Rh- persons. We asked whether transplant immunosuppression with cyclosporine and corticosteroids affects Rh immunization. Nineteen Rh- liver, heart, and heart-lung transplant recipients received 3-153 (median: 10) units of Rh+ RBCs at surgery and were tested for anti-D greater than 2 months later. Three patients developed anti-D at 11-15 days; one may have had an unusually rapid primary immune response and two were secondary to previous exposure by pregnancy. None of the other 16 patients had anti-D when tested 2.5-51 months later (13 patients, greater than 11.5 months). This low rate of Rhesus immunization in association with cyclosporine immunosuppression allows greater flexibility in meeting the transfusion needs of Rh- liver and heart transplant patients. Caution is still advised in young females and in patients who may have been previously exposed to Rh+ RBCs by transfusion or by pregnancy prior to the availability of perinatal Rh immune globulin twenty years ago. Other humoral immune responses to some vaccines or infectious agents may also be impaired in transplant patients.

Unmatched Type O RhD+ Red Blood Cells in Multiple Injured Patients

“…Most other studies reported seroconversion rates between 9.5 and 33% with mean follow-up periods of 14-74 days [9,11,12,14]. Since most multiple injured patients are not immunosuppressed per se, anti-D formation is to be expected more often than in patients with bone marrow transplants or sepsis [26,27,28,29]. …”

Primary anti‐D immunization by weak D type 2 RBCs

“…However, we unequivocally excluded any previous exposure to D (Table 1). In addition, primary anti‐D responses have been observed to occur within 2 weeks 15,16 . The medical history of the recipient may include an autoimmune disorder that could have contributed to his rapid immunization.…”

Red cell antibody problems in 1000 liver transplants

“…Third, in another study we have found that primary anti-D formation was detected infrequently after multiple Rh-incompatible RBC transfusions in organ transplant patients. 18 Some of these posttransplant antibodies may have been detected elsewhere previously and subsequently lost before transplant. Hence, the availability of information from the referring hospital would be desirable.…”