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The development of D antibodies after D‐mismatched kidney transplantation in a setting of reduced immunosuppression
Author(s) -
Habets Thomas H.P.M.,
Vanderlocht Joris,
Straat Ron J.M.H.E.,
van Smaalen Tim C.,
Bos Gerard M.J.,
Beckers Erik A.,
Christiaans Maarten H.L.,
Henskens Yvonne M.C.
Publication year - 2018
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14405
Subject(s) - immunosuppression , transplantation , medicine , antibody , kidney transplantation , panel reactive antibody , immunology , isoantibodies , kidney , pregnancy , fetus , biology , genetics
BACKGROUND D 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 METHODS From 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. RESULTS In 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. CONCLUSION Although 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.