Agishi T, Takahashi K, Yagisawa T, Ota K
Department of Surgery, Tokyo Women's Medical College, Japan.
ASAIO Trans. 1991 Jul-Sep;37(3):M496-8.
Kidney transplantation between ABO incompatible pairs, contraindicated because of a high incidence of hyperacute rejection episodes, has become feasible after provisional removal of anti-A or anti-B antibody from recipient canidates. Initially, a total of 54 patients were scheduled to be transplanted with ABO incompatible kidneys after removal of anti-A or anti-B antibody by immunoadsorption, using A or B antigen expressing trisaccharide immobilized on silica beads. Levels of anti-A and/or anti-B antibody (-ies) were negative (below less than X8 dilution) after three to four immunoadsorption treatments, and, thereafter, kidneys were successfully transplanted in 47 patients (incompatibility in A:21, B:25, AB:1). However, in four patients, anaphylactoid reaction occurred immediately after initiation of immunoadsorption, and double filtration plasmapheresis (DFPP) took place. Kidney transplantation was cancelled in three patients because of rebound to high level of anti-A or anti-B antibody, or appearance of T cell antibody after immunoadsorption.
ABO血型不相容供受者间的肾移植，由于超急性排斥反应发生率高曾被视为禁忌，而在临时去除受者候选者体内的抗A或抗B抗体后已变得可行。最初，共有54例患者计划在通过免疫吸附去除抗A或抗B抗体后接受ABO血型不相容肾移植，免疫吸附采用固定在硅胶珠上表达A或B抗原的三糖。经过三到四次免疫吸附治疗后，抗A和/或抗B抗体水平呈阴性（低于X8稀释度），此后，47例患者成功接受了肾移植（A血型不相容：21例，B血型不相容：25例，AB血型不相容：1例）。然而，4例患者在免疫吸附开始后立即发生类过敏反应，随后进行了双重滤过血浆置换（DFPP）。3例患者因抗A或抗B抗体水平反弹或免疫吸附后出现T细胞抗体而取消了肾移植。
