Alloimmune Thrombocytopenia after Organ Transplantation

• Published in: The New England journal of medicine Vol. 341; no. 20; pp. 1504 - 1507
• Main Authors: West, Kenneth A, Anderson, David R, McAlister, Vivian C, Hewlett, Thomas J.C, Belitsky, Philip, Smith, James W, Kelton, John G
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 11-11-1999
• Subjects: Adult; Antigens, Human Platelet - analysis; Biological and medical sciences; Blood Platelets - immunology; Disease; Female; General aspects; Histocompatibility Testing; HLA Antigens - analysis; Humans; Immune system; Isoantibodies - analysis; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Liver Transplantation - adverse effects; Liver Transplantation - immunology; Male; Medical sciences; Middle Aged; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Purpura, Thrombocytopenic, Idiopathic - etiology; Purpura, Thrombocytopenic, Idiopathic - immunology; Radioimmunoprecipitation Assay; Tissue Donors; Transplantation Chimera; Transplants & implants
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM199911113412004

Transplanted organs, particularly livers and kidneys, carry passenger lymphocytes that can transmit autoimmune diseases
1
or initiate alloimmune disorders
2
in the recipient. We recently treated three unrelated patients who each received an organ (two kidneys and a liver) from the same donor. In all three patients severe alloimmune thrombocytopenia developed as a result of antibodies against the HPA-1a (PLA1) alloantigen. In these three patients the thrombocytopenia was refractory to all medical maneuvers except the transfusion of HPA-1a–negative platelets. In one patient the thrombocytopenia contributed to death. In another, the thrombocytopenia was cured by splenectomy, and in the third patient the . . .