Never event(s) in solid organ transplantation: ABO incompatibility
Olive McGowan1, Jeanette J Foley1, Anthony A Clarkson1, Dale D Gardiner1, John J Richardson1.
1Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, London, United Kingdom; 2Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, London, United Kingdom
Blood group compatibility is a major criterion for allocation of organs for transplantation. Although the barrier of ABO compatibility can be crossed, this is usually undertaken in planned and preconditioned cases. This outlines the case of unintentional ABO incompatible transplantation for three organ recipients.
Case Presentation
A patient admitted following significant trauma required multiple blood products to be transfused. Hypoxic brain damage confirmed, they were subsequently confirmed dead utilising neurological criteria. The patient proceeded to donation after brain death with liver and kidneys transplanted. The blood group was recorded as O on the hospital IT system. Two days later, the SNOD identified that the ABO of the donor had changed to B.
The right kidney was transplanted into a blood group O recipient on dialysis. The implant was uneventful, the recipient had primary function. Day 4, the urine output dropped with a 50umol/l rise in creatinine. The patient was treated with IV steroid, plasma exchange and increased immunosuppression. They responded well and have a creatinine of 89umol/l two months post-transplant. The patient continued to do well.
The left kidney was transplanted into an O recipient on dialysis. Implant uneventful, day two post-transplant sudden reduction in urine output. Imaging showed graft thrombosis, and the patient had a graft nephrectomy Biopsy, antibody mediated rejection.
The liver was transplanted into a group O paediatric who initially did well but showed signs of antibody mediated rejection and was treated with plasmapheresis and intravenous Immunoglobulin. The patient has had a complicated post-operative recovery and required re-grafting. Patient was re-grafted.
Maintaining patient safety in organ transplantation is paramount. Various safety initiatives implemented to ensure that donors who have had a mass transfusion have their ABO recorded correctly. A thorough investigation concluded the hospital system recorded the donors blood group as O for the purposes of urgent O Transfusion purposes.
Patient Safety team , NHS Blood and Transplant All donor families.