Spontaneous and therapeutic glycosidic accommodation of host and graft in ABO(H)-incompatible transplantation, a hypothesis.

In contrast to non-nucleated ABO(H) red cells, which when transfused to a blood group O(H) recipient undergo destruction within minutes, such hyperacute, humoral rejection occurs relatively rare in transplantations of highly nucleated, metabolically active solid organs, and it is extremely rare in liver transplantations (Adams 1991; Della-Guardia et al. 2008). Moreover, a case of transient, selective disappearance of preexisting donor-specific HLA-antibodies after an incompatible liver transplantation, without any rejection episodes, has been reported by Bastiani (2006), and according to Taner et al. (2014)<i> </i>such transient decrease of donor-specific HLA-antibodies is not uncommon after incompatible liver transplantation. In addition, an exponential fall in both anti-A/B reactive IgM and IgG titers were observed after ABO(H) incompatible bone marrow transplantation (Rowley et al. 2000; Lee et al. 2003).These phenomena most likely reflect a complex mechanism, in which pre-existing anti-graft-reactive immunoglobulins are adsorbed on complementary sites on the cell surfaces of the graft, but other than on the surfaces of metabolically weak red cells, appear transiently to be completed by graft-phenotype-specific protective glycosylation and recover when the graft-intrinsic enzymatic power and supply of specific substrates are exhausted.