Abstract
A 57-year-old woman with blood type A Rh-positive was referred to our hospital to receive a liver transplantation resulting from a diagnosis of acute liver failure. She received a deceased liver graft from a man with blood group O Rh-positive. The surgical procedure was carried out uneventfully. Her immunosuppressive regimen was composed of tacrolimus, steroids and mycophenolate mofetil. On day 6 after transplantation, contrast-enhanced computed tomography was performed to investigate the cause of anemia, but no evidence of bleeding was seen. Although 10 units of group A concentrated red blood cells were transfused in 6 days, the value of hematocrit decreased to 17.0%, from 20.8%. The value of haptoglobin was 5 mg/dl. Direct Coombs test showed positive results. The titer of anti-A antibodies was x8. The recipient's lymphocytes were separated from whole blood to perform Y-chromosome-specific in situ hybridization. Under the microscope, one lymphocyte with Y chromosome was seen in 500 lymphocytes. Taken together with these results, anti-A antibodies produced by donor lymphocytes were thought to be involved in the pathogenesis of this case. Following the previous reports, we started to use group O concentrated red blood cells, and the level of hematocrit was elevated. Direct Coombs test became negative on day 19 after transplantation, and the titer of anti-A antibodies became negative on day 107. She was discharged from our hospital on day 55, and remained in good health with no evidence of recurrence.
