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In Pittsburgh, there have been two such cases

In Pittsburgh, there have been two such cases. later. On March 19 and July 29 of the same year, two A to O transplantations were performed, one from a cadaveric donor and the other from a mother, also without perioperative incident. It looked as if ABO matching was irrelevant in renal transplantation and a manuscript with this conclusion was accepted by article including the now familiar table showing permissible patterns of tissue transfer that were designed to avoid placing kidneys into an environment made up of antigraft isoagglutinins (Table 1). Data on isoagglutinin titers was subsequently provided.3 Later, in a classical report, Rapaport et al6 showed how sensitization of human volunteers with purified A or B antigens caused increased titers of isoagglutinins and accelerated (white graft) rejection of subsequently transplanted skin grafts. The circle of evidence seemingly was complete. However, it is worth emphasizing that not all of the mismatched kidneys had rejected and that those that escaped immediate destruction did not seem to pay a later penalty. Table 1 Direction of Acceptable Mismatched Tissue Transfer O to non-OSafeRh? to Rh+SafeRh+ to Rh?Relatively SafeA to non-ADangerousB to non-BDangerousAB to non-ABDangerous Open in a separate window NOTE. O is usually universal donor; AB is universal recipient. Much of the recent interest in the ABO system by transplanters has been Tubercidin focused on reliably surmounting the acute antibody barrier, thereby expanding the available pool of organs. The recent use of A2 kidneys for O recipients Tubercidin is an example. The practice is based on the reports by Breimer and Brynger et al7C8 of Sweden who showed that this A antigen is usually poorly represented in the kidneys of nonsecretor individuals Tubercidin or in patients with A2 blood type. The assumption has been that kidneys from such donors would not be the target of the anti-A isoagglutinins in O or B recipients. However, this newest attempt to ride over an ABO barrier may not be completely safe. On December 28, 1986 in Pittsburgh, a 39-year-old male of O blood type was given a kidney from an Mmp13 A2 cadaveric donor. Cold ischemia time was 35? hours. The kidney underwent hyperacute rejection within five minutes. The anti-A isoagglutinin titers are summarized in Table 2. The anti-A2 titers of both IgG and IgM were high by comparison with those in other candidates for kidneys, livers, or hearts (Table 3). Table 2 Isoagglutinin Titers Before and After Hyperacute Rejection of a Kidney From an A2 Nonsecretor Donor to an O Recipient thead th valign=”bottom” align=”left” rowspan=”1″ colspan=”1″ /th th valign=”bottom” align=”center” rowspan=”1″ colspan=”1″ Anti- /th th valign=”bottom” align=”right” rowspan=”1″ colspan=”1″ Before /th th valign=”bottom” align=”right” rowspan=”1″ colspan=”1″ After /th /thead A1IgM12864IgG 512512A2IgM128128IgG1,024512BIgM25664IgG512256 Open in a separate window Table 3 Isahemagglutinin Titers in Group O Liver, Heart, or Renal Transplant Candidates thead th valign=”bottom” rowspan=”2″ align=”left” colspan=”1″ /th th colspan=”2″ valign=”bottom” align=”center” rowspan=”1″ Anti-A1 (n = 53) hr / /th th colspan=”2″ valign=”bottom” align=”center” rowspan=”1″ Anti-A2 (n = 24) hr / /th th colspan=”2″ valign=”bottom” align=”center” rowspan=”1″ Anti-B (n = 52) hr / /th th valign=”bottom” align=”center” rowspan=”1″ colspan=”1″ IgM /th th valign=”bottom” align=”center” rowspan=”1″ colspan=”1″ IgG /th th valign=”bottom” align=”center” rowspan=”1″ colspan=”1″ IgM /th th valign=”bottom” align=”center” rowspan=”1″ colspan=”1″ IgG /th th valign=”bottom” align=”center” rowspan=”1″ colspan=”1″ IgM /th th valign=”bottom” align=”center” rowspan=”1″ colspan=”1″ IgG /th /thead Median1282563264128256Expected range*32C25664C1,02416C25616C51216C25616C1,024 Open in a separate window NOTE. IgM, 60-minute room temperature saline incubation; IgG, 60-minute 37C saline incubation, then anti-IgG antiglobulin. *90% of patients are in these ranges. Histopathologic examinations showed the same lesions as in the hyperacutely rejected ABO incompatible kidney 25 years previously (Fig 1). IgM and complement were found in the vessel walls (Fig 1). Fortunately, an O kidney became available while the wound was still open and it was inserted with a perfect result. Open in a separate window Fig 1 (A) Glomerulus with congested capillary loops,.