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신장이식 환자에서의 ABO 부(副)-부적합에 의한 용혈성 빈혈
이동렬 ( Dong Ryeol Lee ),강화미 ( Hwa Mi Kang ),김민웅 ( Min Woong Kim ),김치훈 ( Chi Heun Kim ),박종환 ( Jong Hwan Park ),윤지훈 ( Ji Hoon Yoon ),공진민 ( Jin Min Kong ) 대한내과학회 2005 대한내과학회지 Vol.69 No.2
저자들의 경우 ABO 부 부적합 이식 환자 중 ABO항체에 의한 용혈성 빈혈의 발생 빈도가 9%로 비교적 높은데 이는 공여자 특이 수혈(DST)을 시행한 것과 관련이 있을 수 있다. 또한 Azathiopurin, MMF와 같은 B임파구의 증식을 억제하는 약제의 사용이 적었던 것도 빈도의 증가에 기여했을 수 있다. ABO 부(副) 부적합에 의한 신 이식의 경우 초기 원인 불명의 빈혈이 관찰될 때 급성 용혈성 빈혈을 조기에 확인하고 감별 진단하는 것이 필요하며, 적절한 치료를 시행하면 대부분의 경우에서 이식 신 기능 장애 없이 회복이 가능하다. Background : Immune hemolysis secondary to ABO minor incompatibility is a rare graft versus host disease in renal recipients, secondary to anti-ABO antibody produced by lymphocytes of donor origin that reacts against recipient RBCs. Methods : To investigate the incidence and clinical features of immune hemolysis secondary to ABO minor incompatibility in renal allograft recipients, clinical records of 358 renal transplantation performed in Maryknoll Hospital since 1991 were analyzed retrospectively. Results : Fifty four (15%) of 358 renal transplants were ABO minor incompatible. Immune hemolysis secondary to anti-ABO antibody developed in 5 (9.2%) of 54 ABO minor incompatible renal transplant recipients. Immune hemolysis occurred in 3 (13.6%) patients among 22 allografts from blood type O donor to A recipients and 2 (10%) patients among 20 from blood type O donor to B recipients. All 5 patients received cyclosporin with prednisolone, and MMF was administered to one patient additionally. Immune hemolysis developed on 14±3 days after renal transplantation and lasted for about 10±3 days. The maximum reduction of hemoglobin was 3.3±1.0g/dL. All patients required donor type (blood type O) washed RBCs transfusion (5.0±2.6 units per patient) and plasmapheresis were performed in 3 patients (4.0±1.0 per patient). All patients recovered without deterioration of graft function. Age, number of HLA mismatch, creatinine at 1 year after transplantation, frequency of acute rejection and serum cyclosporin level during first 2 weeks were not significantly different between hemolysis group (N=5) and non-hemolysis group (N=49). Living unrelated transplantation is associated with increased incidence of immune hemolysis compared with living related transplantation (p<0.01). Conclusion : Although immune hemolysis secondary to ABO minor incompatibility is uncommon, we experienced cases with marked reduction of hemoglobin that required a large amount of transfusion. Therefore, this type of immune hemolysis needs to be considered as a differential diagnosis of posttransplant hemolysis. As our center routinely performs donor specific transfusion (DST), the incidence may be higher than that of other centers where DST is not usually given.(Korean J Med 69:177-182, 2005)
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