Blood Group Compatibility Research Articles

Simultaneous transplantation of the heart and kidney

Multiple organ transplants have become frequent. Combined heart-and-kidney grafting has been reported recently and we have pursued this in selected cases. To devise a protocol for simultaneous heart-and-kidney transplantation, review our clinical experience with the procedure and the causes of cardiac and renal disease in this group. Seven patients with advanced cardiac failure (LV ejection fraction < 0.29 units; five with IDCM), and chronic renal failure (serum creatinine > 375 mumol/L) due to a variety of causes, were accepted for combined heart-and-kidney transplantation. Four males, of mean age 33 years, underwent the procedure. Each received his organs from a single cadaveric donor with ABO blood group compatibility and a negative 'current' lymphocytotoxic cross-match, but without regard to HLA-antigen matching. Cardiac ischaemic time averaged 3 hours 40 minutes, the renal first warm time was 0 minutes in all cases, and renal cold and second warm ischaemic times averaged 5 hours 17 minutes and 52 minutes respectively. The heart was grafted first and the kidney second in a procedure which averaged seven hours. Immunosuppression was achieved by induction with antithymocyte globulin, thence steroids, azathioprine and cyclosporin A. No patient required post-operative dialysis. One patient had early urological complications requiring operative correction, but no serious opportunistic infections were observed. Early cardiac rejection on biopsy (ISHT grade 3a) was seen in three patients at four-ten weeks and responded promptly to increased steroids, but severe steroid-resistant rejection of both heart and kidney contemporaneously occurred in one of these three at 19 months and required a course of muromonab-CD3. All four patients developed hypertension. Mean creatinine clearance was 1.23 +/- 0.22 mL/second (74 +/- 13 mL/minute) at last follow-up. All four recipients were alive, well and rehabilitated 5, 20, 28 and 35 months after grafting. Two patients died while waiting for the double procedure and another patient eventually died after being taken off the dual waiting list and receiving a renal transplant only. In experienced hands, combined heart-and-kidney transplantation is feasible and offers a compelling therapeutic solution in the treatment of advanced cardiac and renal failure. IDCM is a frequent cause of the heart failure in this group.

Development of a carbohydrate antigen during storage of red cells.

Changes in surface antigens during the aging of red cells led to the expression of epitopes that can induce an immune response. Recently, irregular antibodies detected in the sera of two patients agglutinated in vitro aged red cells. The aging of red cells during storage was examined by flow cytometric analysis using fluorescein isothiocyanate-labeled lectins, fluorescein isothiocyanate-labeled anti-human IgG, and fluorescein isothiocyanate-labeled IgM. Red cells stored for 1 day and 21 days exhibited no difference in the binding of wheat germ agglutinin, Ulex europaeus agglutinin, or concanavalin A. Only soybean agglutinin showed increased binding to old red cells. IgM antibodies present in the sera of two patients induced strong agglutination of stored red cells, but not of fresh red cells of the same or compatible ABO blood groups. The binding of these antibodies did not involve known red cell antigens and could be significantly inhibited by galactose and mannose in a dose-dependent manner. Staining of red cells with sera from both patients indicated that the antibodies recognized the same structure on stored red cells. The number of binding sites on red cells stored for 21 days was between 7,000 and 10,000 per cell. These results demonstrate that, during storage of red cells, gradual expression of galactosyl residues on the red cell membrane occurs.

Erythrocytapheresis as a method for auto-transfusion. A case study in a patient with Vel-antibodies

A 60-year-old man suffering from angina had to undergo percutaneous transluminal coronary angioplasty (PTCA). In the pre-operative screening procedure anti-Vel antibodies were identified. The patient's blood group is O, rr. The prevalence of the blood group O, rr Vel(-) is 1:60,000. Compatible blood groups were not found in the patient's family. The only alternative method to give this patient the necessary units of blood was an auto-transfusion procedure. Because of the patient's clinical condition, however, it was necessary to use an erythrocytapheresis procedure, without changing his blood volume. We performed the erythrocytapheresis using the Fenwal CS-3000. Blood (920 mL) was collected, Ht 0.67 L L , this was equivalent to 3 units of packed cells compared with random donor blood. The erythrocytapheresis procedure was performed without any problem and the PTCA was done without complications or transfusion. The blood is stored in liquid nitrogen in the central laboratory of blood transfusion, Amsterdam.

Correlation of expression of ABH blood group carbohydrate antigens with metastatic potential in human lung carcinomas

METHODS. The expression of ABH blood group carbohydrate antigens was examined histochemically in tumors and adjacent nontumorous tissues of 89 cases of human lung carcinoma in which nontumorous tissues expressed blood group carbohydrate antigens compatible with the erythrocyte blood group types. RESULTS AND CONCLUSIONS. Loss of ABH blood group antigens in lung carcinomas correlated with their metastatic potential, especially with the recurrence of hematogenous metastasis. Consequently, patients with tumors that retained compatible ABH blood group antigens showed a better prognosis than patients with tumors of altered antigenic profiles. The loss of blood group B antigen more significantly affected both the hematogenous metastasis and prognosis than that of A and H antigens.

Single lung transplantation. Morphological surveillance by transbronchial biopsy.

Seven cases of single lung transplantation are reported. The recipients were all below 60 years of age and severely disabled with end-stage lung disease. Transplantation was performed according to ABO blood group compatibility and negative lymphocytotoxic cross-match between donor and recipient irrespective of HLA mismatch. Recipients' diagnoses were sarcoidosis (3), alfa-1 antitrypsin deficiency (3), and idiopathic emphysema (1). Mean recipient age was 48 +/- 2.4 years (range 45-52). Donor age was 29.7 +/- 5.6 years (range 16-49). The immunosuppressive regimen included cyclosporin A, azathioprine, steroids and rabbit antithymocyte globulin. Excellent graft function was achieved. Six patients survived the postoperative period and are alive 4-18 months posttransplant. One patient died after the operation due to pneumonia with respiratory distress syndrome. Graft function was also monitored by transbronchial biopsy, and 57 biopsy procedures were performed without fatal complications. Acute cellular rejection was seen in 16 biopsy specimens from 5 recipients (grade 1 and 2 rejection in 14, grade 3 rejection in 2). Neither severe rejection with septal necrosis (grade 4) nor obliterative bronchiolitis was seen. The rejection rate was 0.03 episodes per patient/month. In contrast to other reports, episodes of cellular rejection occurred throughout the observation period, and were not mainly limited to the first 4 months posttransplant. Graft vascular occlusive disease or chronic vascular rejection was found in 6 biopsy specimens from one recipient. Five patients experienced 7 episodes of cytomegalovirus infection. The cytomegalovirus infection rate was 0.01 episodes per patient/month. The incidence of infection was significantly lower compared to previous studies of rejection in other lung graft combinations. Both infections and rejection episodes may contribute to the development of obliterative bronchiolitis. Almost one third of the specimens (30%) showed lymphocytic bronchitis without perivascular inflammation. The absence of perivascular infiltrates and exclusion of infectious agents leaves in question the aetiology of this inflammation. The lymphocytic bronchitis could be ischaemic, related to aspiration, or represent recurrent sarcoidosis, or, in fact, express bronchial rejection. All biopsy specimens regarded as rejection with cellular infiltrates in the lung parenchyma also showed a lymphocytic bronchitis. The impact of HLA mismatch on cellular and vascular rejection is unclear. Transbronchial biopsy is a reasonably safe and reliable method in the diagnosis of rejection and infection in single lung transplantation.

Current experience with renal transplantation across the ABO barrier

Solid organ transplantation has traditionally been governed by the rules of blood group compatibility. Thus, it has been demonstrated that crossing the ABO blood group barrier generally results in hyperacute rejection. However, the A2 subtype of the blood group A is a weaker antigen. Under certain circumstances, organs from donors with blood group A2 can be transplanted across the ABO blood group barrier into recipients of O or B blood type. Since 1986, 33 patients including 24 blood group O and 9 blood group B patients received A2 (30) or A2B (3) donor kidneys. Both cadaver donor (31) and living-related grafts (2) have been undertaken. The mean follow-up since transplantation for the 21 patients with functioning grafts is 36 months, with a 67.2% current graft survival. Immunosuppression for these transplants consisted of azathioprine, prednisone, and cyclosporine, often in combination with prophylactic OKT3 or antilymphocyte globulin as protocol dictated. Special immunosuppressive protocols such as splenectomy or plasmapheresis were not used. The serum of the potential recipient was analyzed for immunoglobulin G (IgG) and immunoglobulin M (IgM) forms of antibody against A1 and A2 red blood cells. There is a strong correlation between a low (less than or equal to 1:8) anti-A1 IgG titer and both early and long-term graft function. Recipients with an IgG titer greater than 1:8 in the pretransplant serum had a much higher incidence of early graft failure. We no longer recommend transplantation of A2 kidneys into O or B recipients with a pretransplant titer of greater than 1:8 but found that recipients with low titers have graft function rates essentially equal to those of ABO-compatible patients. Patients with blood group B have, over time, lower anti-A IgG titers than do blood group O patients. In addition, the graft survival among blood group B patients is 89% compared with 58% among group O recipients. This may be due to the generally low titers found in blood group B recipients. Since instituting a policy in 1988 of not transplanting the kidney when the anti-A IgG titer is greater than 1:8, the survival in O patients is 88%. We recommend the screening of all organ donors with blood group A for the A2 subgroup and believe that transplantation can be safely and successfully performed in certain patients with blood group O or B.(ABSTRACT TRUNCATED AT 400 WORDS)

Erythrocyte apheresis as a method for autologous blood transfusion--a case study in a patient with Vel-antibodies.

A 60-year old man was suffering from angina and a percutaneous transluminal coronary angioplasty (PTCA) had to be done. In the preoperative screening procedure antibodies anti-Vel were identified. The patients blood group is 0, rr. The prevalence of the blood group 0, rr, Vel(-) is 1:60,000. Compatible blood groups were not found in the patients family. The only alternative method to give this patient his necessary units of blood was an autologous transfusion procedure, however, because of the patients clinical condition it was necessary to use an erythrocyte apheresis procedure without changing his blood volume. We performed erythrocyte apheresis, using the Fenwal CS-3000. 920 ml blood was collected, Ht 0.67 l/l, enough for three units packed cells compared with random donor blood. The erythrocyte apheresis procedure was performed without any problem. The PTCA was done without complications and transfusions. The units of blood are stored in liquid nitrogen in the central laboratory of blood transfusion, Amsterdam.

Liver transplantation in Taiwan: the Chang Gung experience

Between March 1984 and February 1991, six orthotopic liver transplantations were performed at the Chang Gung Memorial Hospital in Taiwan. The indications for transplantation were Wilson's disease (5 patients) and biliary atresia (1 patient). Donors and recipients were matched only for size and ABO blood group compatibility, and the recipient operations were performed without the use of a venovenous bypass. Arterial reconstruction was carried out by end-to-end hepatic artery anastomosis (4), thoracic aortic conduit (1), or interposition of an iliac artery graft (1), whereas biliary reconstruction was accomplished by a choledochocholedochostomy using a T-tube stent (4) or a choledochocholedochostomy using an external cholecystostomy without stenting (2). Biliary complications occurred in three patients, and all required additional surgery. The average duration of donor-liver cold ischemia, operating time, and blood loss during surgery were 7 h and 50 min (range, 4.5-9 h), 13.5 h (range, 11.8-17 h), and 4,385 ml (range, 750-12,000 ml), respectively. The immunosuppressive regimens included a cyclosporin-steroid combination (n = 2) and a triple-drug combination (n = 4). All except one of the surviving patients experienced at least one rejection episode that was reversed by a methyl-prednisolone bolus and/or recycle. One patient developed a primary cytomegalovirus (CMV) infection that responded well to Ganciclovir treatment. Two of the patients died, one of injuries sustained in a traffic accident 3 years after transplantation, and the other of massive upper gastrointestinal bleeding. The overall survival value at 3 months was 83%, and the follow-up period ranged from 3 months to 7 years. All of the survivors have achieved complete rehabilitation and currently enjoy an excellent quality of life with normal liver function. Although the present study involved a small number of cases, our results indicate that liver transplantation can be successfully achieved in a high proportion of patients with acceptable morbidity, mortality, and cost in an Asian setting. The extreme shortage of donor organs is currently the most important obstacle limiting the application of liver transplantation in Taiwan.

IMMUNOLOGICAL COMPATIBILITY BETWEEN THE CHACMA BABOON AND MAN

Predictions of an increasing shortage of donor organs for the future has led to a resurgence of interest in xenotransplantation. We have methodically assessed the immunological compatibility of humans against the chacma baboon with a view to narrowing the gap of concordance by careful immunological screening. The necessity of major blood group compatibility in xenotransplantation is now established. While no group O universal donor exists in the baboon, groups A (45%), B (15%), and AB (40%) are well represented. Baboon histocompatibility antigens could not be precisely defined using human antisera. This does not necessarily imply lack of homology between the species, as we have shown specific crossreactivity of numerous antihuman monoclonal antibodies with baboon leukocytes. Normal humans do not exhibit preformed agglutinins to erythrocytes of the chacma baboon (Papio ursinus orientalis)) but cytotoxic antibodies are occasionally found. Sera from allosensitized patients may contain crossreacting hemagglutinins, leukoagglutinins and complement-dependent cytotoxic antibodies. Binding of human immunoglobulin-G and -M to baboon targets was demonstrated by flow cytometry. Negative crossmatch combinations for antibodies of the IgG subclass were easily found, but IgM antibodies from allosensitized patients were polyspecific in their action. In vitro assessment of lymphocyte mediated cytotoxicity showed that preformed cellular immunity between the species was rare. The response of human lymphocytes to xenoantigen stimulation in mixed lymphocyte cultures showed a normal distribution, permitting the selection of low-responding combinations. Screening for viruses, especially HTLV-1 and Coxsackie-BL34, is important. These findings demonstrate a closer degree of concordance than has previously been suspected.

Expression of blood group-related antigens and Helix pomatia agglutinin in malignant pleural mesothelioma and pulmonary adenocarcinoma

In an attempt to differentiate malignant pleural mesothelioma from pulmonary adenocarcinoma by histochemical and immunohistochemical means, the glycoconjugate profiles of five reactive mesothelial lesions, 29 mesotheliomas (20 epithelial, three biphasic, and six fibrous types), and 38 well-differentiated pulmonary adenocarcinomas (34 papillary, two tubular, and two bronchioloalveolar types) were tested with ABH blood group-related antigens (BGR-Ag) antibody and Helix pomatia agglutinin (HPA) which agglutinates human type A erythrocytes. Formalin-fixed, paraffin-embedded sections were stained by the avidinbiotin-peroxidase complex method. Reactive mesothelial lesions and malignant mesothelioma of the pleura were not stainable with BGR-Ag antibody or HPA, irrespective of the blood group type. In pulmonary adenocarcinoma, however, the test with BGR-Ag antibody showed a high positive rate with the compatible blood group type, especially in type O cases (83%). Using HPA, reactions of adenocarcinoma with types A and AB also demonstrated high positive results (94% and 100%, respectively), but even with types B and O positive reactions occurred in 80% and 33% of cases, respectively. The findings suggest that positive reactions with either BGR-Ag antibody or HPA can be indicative of pulmonary adenocarcinoma.

Saccharide residues in human gingiva as revealed with fluorochrome‐coupled lectins

The histochemical binding of 16 fluorochrome-conjugated lectins to human marginal gingiva was investigated. Of a total of 14 galactose/N-acetylgalactosamine (Gal/GalNAc)-specific lectins, Dolichos biflorus (DBA), Helix pomatia (HPA), and Helix aspersa agglutinins (HAA) were blood group A-reactive whereas Griffonia simplicifolia I-B4 (GSA-I-B4) and Sophora japonica (SJA) agglutinins were blood group B-reactive. HPA, HAA and GSA-I-B4 bound to all suprabasal epithelial cells and to vascular endothelia in tissues with compatible blood groups and detected only upper epithelial cells in tissues lacking the respective blood group antigens. SJA, on the other hand, bound to suprabasal epithelial cells and to endothelial cells in specimens from blood group B, AB and A individuals. DBA gave a heterogeneous labeling of upper epithelial cells in blood group A, AB and B specimens but not in O specimens and did not react with endothelia in any of the tissue samples. DBA bound, instead, consistently to mast cells in gingival lamina propria. Of the other Gal/GalNAc-reactive lectins, 2 bound to suprabasal epithelial cells and 7 to all viable cell layers in gingival epithelium. The binding of these lectins was blood group-independent. Of the fucose-specific lectins, Ulex europaeus agglutinin I (UEA-I) gave an intense suprabasal cell membrane-type of epithelial fluorescence in blood group O specimens and a more diffuse staining in other specimens and recognized endothelial cells in a blood group-independent way. Anguilla anguilla agglutinin (AAA) gave a blood group-independent epithelial staining and bound heterogeneously to endothelial cells only in blood group O samples.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of ABO blood group compatibility in heart transplantation between closely related animal species: An experimental study using the vervet monkey to baboon cardiac xenograft model

The role of ABO blood group compatibility on graft survival when transplantation is performed between closely related animal species is uncertain. Heart transplants (in the neck) were performed between donor vervet monkeys and recipient baboons; no immunosuppressive therapy was given. Survival in ABO-compatible pairs (group 1, n = 9) was for a mean of 10.3 (+/- 5.2) days, which was not significantly different from that in ABO-incompatible pairs (group 2, n = 9: mean survival 7.3 +/- 5.6 days). In group 2, however, three hearts were rejected hyperacutely within 60 minutes, whereas in group 1 only one heart was rejected within 24 hours (not significant). Preformed anti-vervet monkey antibody was present in only one of 18 baboons, but developed in eight others. ABO-specific antibodies were present in all nine group 2 baboons and increased in titer in six cases. Histopathologic features of vascular (humoral) rejection, sometimes associated with cellular infiltration, were seen in a majority of hearts in both groups. Though the number of animals in this study was small, ABO-incompatibility would not appear to be a major factor in cardiac xenograft survival when transplantation is performed between closely related primate species, though early hyperacute rejection would seem more likely to occur when blood group incompatibility is present.

Immunologic transfusion reactions.

ABO blood group incompatibility is of major concern because the antibodies frequently cause intravascular destruction leading to the most clinically severe complications. Irregular erythrocyte antibodies seldom cause intravascular destruction. However, when the antibodies bind complement and are present in high concentration the extravascular destruction occurs predominantly in the liver and may cause a clinically severe reaction with hemoglobinemia, shock and DIC. Those IgG class antibodies which do not bind complement cause a spleen-mediated, more or less drastically shortened life span of the red cells with unpleasant but usually not life threatening consequences for the patient. The transfusion reaction may occur with a delay of several days. Compatibility testing may consist of either a cross-match performed in such a way that both ABO incompatibility and irregular antibodies are detected, or a type-and-screen procedure. In the latter a computerized delivery control checking the patient's previous serological history and the donor/recipient compatibility is a recent improvement and rationalization. In an acute situation a reduction of the normal security measures may be necessary. The clinician responsible for the patient must know the time needed for carrying out an acute blood group determination and compatibility test in the hospital and must give instructions about what normal security measures that should be refrained from. Blood group incompatible transfusions have nowadays a much better prognosis than earlier, provided a rapid diagnosis can be made and appropriate treatment can be started promptly. Formation of antibodies against leukocyte/thrombocyte antigens is a frequent consequence of transfusion which, however, can be prevented by modern blood component therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

The first 100 liver transplants at UCLA.

A clinical program in liver transplantation was begun at UCLA in 1984 after a period of laboratory investigation. The first 100 orthotopic liver transplants (OLT) were performed in 83 patients (43 adults and 40 children) between February 1, 1984 and November 1, 1986. Donors and recipients were matched only for size and ABO blood group compatibility, with OLT performed across blood groups in 28 patients. Standard operative techniques were used, including venous-venous bypass in adults. Arterial reconstruction was performed using an aortic Carrel patch or "branch patch" in 65% of cases and by end-to-end or aortic conduit techniques in the remainder. The hepatic artery thrombosis rate was 5%. Biliary reconstruction was choledochocholedochostomy in 67 OLT and Roux-en-Y choledochojejunostomy in 33 (complication rate of 24% and 24%, respectively). Average lengths and ranges of donor liver ischemia, operating time, and blood replacement were 4 hours (range: 1-10 hours), 7.6 hours (range: 4-15 hours), and 17 units packed cells (range: 2-220 units). Immunosuppressive regimen was cyclosporine-steroid combination, with monoclonal anti-T-cell antibody (OKT3) used for refractory rejection. All patients had one or more complications: pulmonary (78%), infectious (51%), renal dialysis (25%), neurologic (22%). All patients had at least one episode of acute rejection, and 3.6% had chronic rejection. Retransplantation was needed in nine patients once and in four patients twice. The overall retransplant survival rate was 54%, and two of four patients who received a second retransplant are alive. Sixty-three of the 83 patients (76%) are alive (adults 72%, children 80%). The 1- and 2-year actuarial survival rate is 73% (adults 68%, children 78%). Thirty-eight of 43 patients (88%) who had transplantation in the past year are alive. Of 14 perioperative variables assessed as predictors of early mortality, only postoperative dialysis (p less than 0.0005) and presence of severe rejection (p less than 0.01) had statistical significance. Seventy per cent of adults returned to work, and 84% of children had normal or accelerated growth. A new program in liver transplantation provides a dramatic option in patient care and an academic stimulus to the entire medical center.

14. LIVER TRANSPLANTATION – CAMBRIDGE/KING'S SERIES

Between December 1983 and August 1986, 84 children were assessed for possible liver transplant. 18, mainly infants with biliary atresia, were not accepted because of features which made successful trasnplantation unlikely. 4 children were withdrawn from the programme by their parents. 9 died before a donor of suitable size or compatible blood group could be found. 9 await transplantation, 9 have been accepted for liver transplantation but are at present sufficiently well for this to be postponed. 35, aged 7mnths-16yrs, had liver grafts. Of these, 17 had biliary atresia, 5 fulminant or subacute hepatic failure, 3 malignant liver tumours and 2 metabolic disease. 15 died, 9 in the first 2 months mainly from primary graft failure or vascular thrombosis, later deaths being due to rejection, infection or dissemination of malignant disease. 2 died of disease in other organs with a normally functioning transplanted liver. 2 of the survivors have had a second liver transplant. 3 have significant hepatobiliary problems which may require retransplantation. The majority of survivors are engaged in normal activities for their age, growing and developing satisfactorily with normal biochemical tests of liver function & complete regression of cirrhosis. Their excellent quality of live is encouraging. Lack of donors, particularly for young infants & prevention of post-operative rejection & infection are continuing problems.

Histocompatibility Testing for Keratoplasty in High-risk Patients

Forty-eight consecutive patients at high risk for corneal graft rejection were transplanted with corneas from donors selected on the basis of a negative lymphocyte crossmatch, ABO blood group compatibility, and maximized HLA-A, -B matching. Graft survival in this study group was compared to a retrospective control group of 72 consecutive high-risk transplants performed in patients receiving randomly obtained corneal donors. Demographic parameters, cause of primary disease, and incidence of prior graft rejection were no different between the two groups. Graft survival at one year, calculated by the Kaplan-Meier method, was 78% for the negative crossmatch study group vs 52% in the uncrossmatched control group (P < 0.05%). All graft failures in the negative crossmatch group were in poorly HLA matched recipients. While patients with evidence of nondonor specific humoral presensitization to HLA antigens experienced earlier graft rejection, overall graft survival was not associated with such nonspecific presensitization. These findings indicate that prospective histocompatibility testing can improve corneal allograft survival for high-risk patients by better identification of appropriate donors.

Beneficial Effects of Histocompatibility in High-Risk Corneal Transplantation

Forty-six consecutive patients at high risk for corneal graft rejection because of significant vascularization or previous graft rejection received transplanted corneas from donors who were selected on the basis of a negative lymphocyte crossmatch, ABO antigen blood group compatibility, and maximized HLA-A and HLA-B antigen matching. Graft survival in this study group was compared to that in a retrospective control group of 71 consecutive high-risk transplants performed in patients receiving corneas obtained randomly. We found no differences between groups in terms of demographic factors, cause of primary corneal disease, or the incidence of previous graft rejection. However, graft survival in the control group was only 49% (35 of 71) vs 83% (38 of 46) for the study group (P less than .001) with mean follow-up times of 29.6 and 15.5 months, respectively. All graft failures in the study group were in recipients with poorly matched HLA antigens. Patients with evidence of humoral presensitization to HLA antigen had twice the rejection rate of unsensitized recipients (three of 11 vs five of 35).

Anti-erythrocyte antibodies, leukocytotoxins and human renal allograft survival.

ABO blood group compatibility is generally required for successful human kidney transplants and new data suggest donor-recipient incompatibility for the Lewis or multiple minor blood groups is detrimental. This is of special importance in the setting of liberal transfusions prior to transplant. To assess the impact of immunizing exposure to disparate blood groups of ABO-matched transfusions and kidney transplants, we studied the interrelationships of anti-erythrocyte antibodies, leukocytotoxins and graft survival in 42 kidney transplant recipients. Three hundred forty-four sera were screened for anti-erythrocyte antibodies using standard hemagglutination techniques and leukocytotoxins, using the antiglobulin method. Statistical analysis by computer used a 2 x 2 x 2 contingency table with model fitting. Only 13 of 42 patients had anti-erythrocyte antibodies at some time: anti-I (4); anti-Kell (1); cold panagglutinin (7); unidentifiable agglutinin (1). Of 42 patients, 16 had no detectable leukocytotoxins. By computer analysis, immunizations to blood group and HLA antigens were independent phenomena. Analysis showed that leukocytotoxins, but not anti-erythrocyte antibodies, were associated with poor graft survival. A computer generated probability of graft survival by antibody status is presented. We conclude that immunization to blood group antigens is not common, is largely non-specific, and is not detrimental to kidney graft survival.

Déterminants antigéniques avec spécificité de groupe sanguin compatible et non compatible dans les mucines tumorales

Summary Glycopeptides of similar composition were obtained from pronasic digests of pseudomyxomatous mucin. They were isolated by cationic detergents and ethanol precipitation. These glycopeptides had a very high content in threonine (50 % of amino acid content) proline (25 % of amino acid content) and N-acetylgalactosamine. They were different of carcinoembryonic antigen and neoantigens NCA, NCA II. Tested by hemagglutination inhibition they exhibited compatible blood group activity B, H with hemagglutinins and lectins. They were also reactive towards Dolichos lectin and exhibited an A 1 like activity involving N-acetylgalactosamine. These glycopeptides were subjected to degradation with alkaline borohydride under conditions which release carbohydrate from the protein backbone. The products of the alkaline degradation were dialyzed. The dialysable chains were chromatographied on Bio-Gel P 2 and then purified by paper chromatography. Oligosaccharides were isolated, monosaccharide with only N-acetylgalactosamine and some more complex oligosaccharides with N-acetylgalactosamine at their non reducing end. The different carbohydrate chains were linked to the protein through O-glycosidic bands involving N-acetylgalactosamine and threonine and serine. The amino acid composition and the carbohydrate components are agree with main branchings involving numerous carbohydrate side chains, most of them being short. From these results, different questions arised about the presence of an A 1 activity which involves Gal-N-Ac in tumoral mucin. This disorder could be explained, by some error in the protein biosynthesis, or in the regulator mechanism that controls glycosyltransferase activities. The protein backbone would contain repeated consecutive branchings. The presence of monosaccharides would result from inhibition or suppression of galactosyl and N-Acetylglucosaminyltransferases. The presence of N-Acetylgalactosamine at the non reducing end of the carbohydrate chains would result from derepression of N-Acetylgalactosaminyltransferase.

Blood group compatibility and aortic valve allotransplantation in man

Immunologic injury is an important contributing factor in failure of aortic valve allografts. The etiology of this immune reaction is unknown, but blood group antibodies have been postulated. In 46 patients, ABO and rhesus blood group compatibility bore no relationship between the success or failure or aortic valve allotransplantation. Therefore, circulating blood group antibodies do not contribute to valve failure, and recipients do not have to receive aortic valve allografts matched for ABO or rhesus compatibility.