Ivanovski Ninoslav, Popov Zivko, Masin-Spasovska Jelka, Dimcevska Anita Hristova, Kolevski Perko
Department of Nephrology, University Clinical Center, Republic of Macedonia.
Xenotransplantation. 2006 Mar;13(2):123-5. doi: 10.1111/j.1399-3089.2006.00294.x.
Due to the growing organ shortage in the Balkans and still underdeveloped cadaver transplantation, we started accepting living expanded criteria renal donors including elderly, marginal and unrelated donors (spouses, etc). The ABO-incompatible renal transplantation was initiated last year. The first two successful cases are presented.
A 40-yr-old mother (blood group A1B) and a 57-yr-old husband (blood group B) were considered as suitable donors for an 18-yr-old daughter (blood group B) and a 52-yr-old wife (blood group O). Both the recipients had a relatively long dialysis treatment before the surgery. The anti-A1 and anti-B titer of isoaglutinins was 1 : 64 in both the recipients before the procedure. A routine laparoscopic splenectomy was performed 40 and 45 days before the transplantation, without any complications. In the 10 days pre-conditioning period, rituximab was administered in a single dose of 375 mg/m2. At the same time four to five plasmaphereses were performed to reduce the isoaglutinins to below 1 : 4. On the last night before the surgery intravenous immunoglobulin (IVIG) in a dose of 0.5 g/kg/bw was administered. Standard induction and maintenance therapy was introduced (Dacllizumab, CyA-Neoral, MMF and steroids) according to the accepted policy in our transplant center. The routine plasmaphereses were performed in the first 2 weeks after transplantation to keep the isoaglutinins titer below 1 : 8.
Ten and 6 months after the surgery both recipients are doing well. Their graft function remains stable (actual serum creatinin 140 and 230 microm/L, respectively). In the 1 month protocol biopsy a subclinical cellular and mild vascular rejection occurred, and both recipients were treated by steroid pulse therapy. One to two additional plasmaphereses were performed. The regularly monitored anti-A1 and anti-B isoaglutinins titer was kept below 1 : 8 during a period of follow-up.
The first short-term results fully justify the ABO-incompatible living renal transplantation. The authors consider ABO-incompatible transplantation as a safe and promising procedure which may, together with expanded criteria living donors, ameliorate the actual donor shortage in the region.
由于巴尔干地区器官短缺问题日益严重，尸体移植仍不发达，我们开始接受扩大标准的活体肾供体，包括老年人、边缘供体和非亲属供体（配偶等）。去年开始了ABO血型不相容肾移植。现介绍前两例成功病例。
一名40岁的母亲（A1B血型）和一名57岁的丈夫（B血型）被认为是一名18岁女儿（B血型）和一名52岁妻子（O血型）的合适供体。两名受者在手术前都接受了较长时间的透析治疗。术前两名受者的同种凝集素抗A1和抗B效价均为1:64。在移植前40天和45天进行了常规腹腔镜脾切除术，无任何并发症。在10天的预处理期内，单剂量375mg/m²给予利妥昔单抗。同时进行四到五次血浆置换，将同种凝集素降低至1:4以下。手术前一晚静脉注射剂量为0.5g/kg体重的静脉注射免疫球蛋白（IVIG）。根据我们移植中心的既定政策，采用标准的诱导和维持治疗（达利珠单抗、环孢素新山地明、霉酚酸酯和类固醇）。移植后的前2周进行常规血浆置换，以使同种凝集素效价保持在1:8以下。
手术后10个月和6个月，两名受者情况良好。他们的移植肾功能保持稳定（实际血清肌酐分别为140和230微摩尔/升）。在术后1个月的方案活检中发生了亚临床细胞性和轻度血管排斥反应，两名受者均接受了类固醇脉冲治疗。又进行了一到两次血浆置换。在随访期间，定期监测的抗A1和抗B同种凝集素效价保持在1:8以下。
首批短期结果充分证明了ABO血型不相容活体肾移植的合理性。作者认为ABO血型不相容移植是一种安全且有前景的手术，它可能与扩大标准的活体供体一起，缓解该地区目前供体短缺的状况。
