Renal allograft failure and cold red blood cell autoagglutinins

Ten patients in a retrospective review of 250 kidney transplant recipients had RBC-cold agglutinins reactive at 22 C. Fourteen transplants were performed in those 10 patients. Five of nine cold renal allografts failed to function. Two of these recipients later had successful transplants when the kidneys were warmed before reestablishment of blood flow. Three other patients with cold RBC autoagglutinins had immediate renal function when the transplanted kidneys were warmed. In a prospective study of 126 patients, 59% had cold RBC agglutinins at 4 C and 11% were alos reactive at 22 C. Red blood cell-cold autoagglutinins appear to be a preventable cause of acute renal allograft failure. The titer and thermal amplitude of these antibodies are probably of major importance and should always be determined before organ transplantation.