Temporary donor-derived B-lymphocyte microchimerism leading to hemolysis in minor AB0-incompatible renal transplantation

AT THE BEGINNING of the 21st century the term “compatibility” took on new relevance. The compatibility in the ABO system should mean “identity”. The nonidentical transfusions, bone marrow and solid organ transplants, should be divided into minor and major incompatible groups with unambiguous distinctions in our procedure manuals. To date, the most important principle in transfusion and transplantation medicine has been to avoid the transmission of any incompatible antigen of the ABO system. There has been even less concern regarding the transfusion of incompatible antibodies. A unique way of transmitting incompatible antibodies is by transplantation of antibody-producing B lymphocytes through bone marrow or solid organ transplantation. This kind of microchimerism may be followed by incompatible antibody production leading to delayed moderate hemolysis. Donor-derived ABO antibodies have a tendency to destroy the recipient’s red blood cells.