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ABO-incompatible marrow transplants

W I Bensinger, C D Buckner, E D Thomas

    Transplantation
    |April 1, 1982
    PubMed
    Summary
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    ABO-incompatible marrow transplants show similar outcomes to ABO-compatible ones. High pre-transplant antibody levels increase post-transplant antibody return but do not affect engraftment or survival.

    Area of Science:

    • Hematology
    • Immunology
    • Transplantation

    Background:

    • ABO-incompatible marrow transplants were historically challenging due to antibody-mediated rejection.
    • Understanding antibody dynamics post-transplant is crucial for optimizing outcomes.

    Purpose of the Study:

    • To evaluate the impact of pre-transplant antibody levels on post-transplant antibody return in ABO-incompatible marrow transplants.
    • To compare engraftment, survival, and complication rates between ABO-incompatible and ABO-compatible marrow transplants.
    • To assess factors influencing post-transplant antibody levels.

    Main Methods:

    • Analysis of data from 81 ABO-incompatible marrow transplants conducted between 1972 and 1980.
    • Correlation of pre-transplant anti-red blood cell antibody levels (IgG and IgM) with post-transplant antibody return.

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  • Comparison of outcomes including engraftment time, survival, rejection incidence, and graft-versus-host disease between ABO-incompatible and ABO-compatible transplant groups.

    • Main Results:

    • Patients with high pre-transplant antibody levels had a significantly increased probability of antibody return post-transplant (for both IgG and IgM).
    • Post-transplant antibody return did not impact engraftment, survival, or blood product requirements.
    • ABO-incompatible transplants demonstrated similar engraftment times, survival rates, and incidence of rejection and graft-versus-host disease compared to ABO-compatible transplants.
    • Neither pre-transplant treatment nor graft-versus-host disease affected post-transplant antibody levels.

    Conclusions:

    • ABO-incompatible marrow transplants can be performed with comparable morbidity and mortality to ABO-compatible grafts.
    • Pre-transplant antibody levels predict post-transplant antibody return but do not influence key clinical outcomes.
    • Techniques for antibody removal may have broader applications in other organ transplant settings.