Red blood cell alloantibodies dictating solid organ transplant decisions: Two case reports

Presence of antibodies directed against certain red cell antigens in a solid organ transplant recipient can complicate transplant outcome if the donor is positive for those antigen(s). Therefore, these are immunohematological barriers that affect clinical decisions taken in such scenarios. Case A: A 43 year old woman who was a case of chronic kidney disease (CKD). She was on dialysis while awaiting a renal transplant. During her pre-transplant workup, she was found to have anti-Jka and anti-e antibodies making it a challenging scenario. She was listed as a prospective match for a cadaver kidney. Complement dependant Cytotoxicity (CDC) cross-match was negative. But an additional typing was requested for the donor. When found to be Jka-, the next concern arose for any possible blood requirement during the transplant due to her anti-e antibody. Since the required units would have to be Jka-e-, a rare phenotype, it was decided to not allocate the current organ, put her back on dialysis and suitably prepare for the transplant by taking the time to correct her anemia, decide on a suitable operative strategy to minimize blood loss and attempt to arrange antigen negative units for her before the surgery. Case B: A 64 year old female patient suffered from non-alcoholic steatohepatitis(NASH) and was being considered for liver transplant from her son. However routine immunohematological testing before the transplant showed she had anti- Fya antibodies and was Fya-. Her liver donor was Fya+, but all the anticipated required red cell units needed to be Fya-. A total of 56 units were cross-matched to find 5 compatible units. Her surgery was uneventful and she required 3 units of those PRBCs during it. Red cell antigen systems should be taken into consideration in transplantations, atleast on a case-to-case basis, if not routinely, especially in the context of peri-transplant transfusion needs.