Kaihara S, Okamoto M, Akioka K, Ogino S, Higuchi A, Kadotani Y, Nobori S, Yoshimura N
Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Transplant Proc. 2005 May;37(4):1804-5. doi: 10.1016/j.transproceed.2005.02.107.
We reviewed ABO-incompatible living donor kidney transplantations (LDKT) performed in our institute.
Fourteen ABO-incompatible LDKT were carried out in the first era (September 1990-August 1996) and 13 were in the second era (October 2001-July 2004). All patients were treated with sessions of plasmapheresis before transplantation to reduce antibody titers <1:8. In the second era, those with rebound increase of antibody titers >1:64 after repeated plasmapheresis were not subjected to transplantation. Posttransplantation immunosuppression consisted of cyclosporin, predonisone, azathioprine, gusperimus hydrochloride (DSG), and antilymphocyte globulin (ALG) in the first era, and tacrolimus, mycophenolate mofetil, predonisone, and DSG in the second era. Splenectomy was performed during the transplantation. Anticoagulant therapy was introduced in the second era.
One-, 2-, and 5-year graft survival in the first era was 57%, 57%, and 50%, respectively, values that were significantly lower than those of ABO-compatible cases in the same period (n = 101), namely, 1-, 3-, and 5-year graft survival rates 93%, 83%, and 76%, respectively. The main reason for graft and patient losses was infectious complications. In the second era, no recipient suffered a severe infectious complication and 1- and 2-year graft survival rates were both 100%. Four patients in the first era and 1 in the second era experienced a graft rejection episode between 10 days and 14 months after transplantation, but they were successfully treated with steroid pulse therapy.
Although patients with high blood group antibody titers remain problematic, ABO-incompatible LDKT is an increasingly viable option for patients whose only donor is blood group-incompatible.
我们回顾了在我院进行的ABO血型不相容的活体供肾移植（LDKT）情况。
在第一个时期（1990年9月至1996年8月）进行了14例ABO血型不相容的LDKT，在第二个时期（2001年10月至2004年7月）进行了13例。所有患者在移植前均接受了多次血浆置换治疗，以将抗体滴度降至<1:8。在第二个时期，那些在反复血浆置换后抗体滴度反弹升高>1:64的患者未接受移植。第一个时期移植后的免疫抑制方案包括环孢素、泼尼松、硫唑嘌呤、盐酸古司他丁（DSG）和抗淋巴细胞球蛋白（ALG），第二个时期为他克莫司、霉酚酸酯、泼尼松和DSG。移植期间进行了脾切除术。在第二个时期引入了抗凝治疗。
第一个时期1年、2年和5年的移植肾存活率分别为57%、57%和50%，这些值显著低于同期ABO血型相容病例（n = 101）的存活率，即1年、3年和5年的移植肾存活率分别为93%、83%和76%。移植肾和患者丧失的主要原因是感染性并发症。在第二个时期，没有受者发生严重感染性并发症，1年和2年的移植肾存活率均为100%。第一个时期有4例患者和第二个时期有1例患者在移植后10天至14个月发生了移植肾排斥反应，但通过类固醇冲击治疗成功治愈。
尽管高血型抗体滴度的患者仍然存在问题，但对于唯一供体血型不相容的患者来说，ABO血型不相容的LDKT是一个越来越可行的选择。
