Wilpert Jochen, Geyer Marcel, Pisarski Przemyslaw, Drognitz Oliver, Schulz-Huotari Christian, Gropp Anette, Goebel Heike, Gerke Peter, Teschner Sven, Walz Gerd, Donauer Johannes
Renal Division, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
Nephrol Dial Transplant. 2007 Oct;22(10):3048-51. doi: 10.1093/ndt/gfm460. Epub 2007 Jul 10.
Since 2001, approximately 100 ABO-incompatible kidney transplantations have been performed in Europe. The standard protocol, employed by most transplant centres, uses rituximab and scheduled pre-emptive antigen-specific immunoadsorption on post-operative days 3, 6 and 9.
Our centre has performed 22 ABO-incompatible kidney transplantations since 2004, using a different approach; like in Sweden, all patients received immunoadsorptions preoperatively, but instead of scheduling pre-emptive post-transplant immunoadsorptions, we submitted patients to immunoadsorptions post-operatively only, if their isoagglutinine titers (IgG-Anti-A or -B) exceeded certain thresholds. These thresholds were greater than 1 : 8 in the first post-operative week and greater than 1 : 16 in the second post-operative week, respectively.
A shorter pre-operative length on dialysis, a blood-type constellation of donor A1/recipient 0 and 9a high initial starting-titer were identified as predictors for post-operative immunoadsorptions.
Using this on-demand strategy, our data reveal that a titer-dependent protocol reduces costs at no additional risk for the patient.
自2001年以来，欧洲已进行了约100例ABO血型不相容肾移植。大多数移植中心采用的标准方案是使用利妥昔单抗，并在术后第3、6和9天安排预防性抗原特异性免疫吸附。
自2004年以来，我们中心采用了不同的方法进行了22例ABO血型不相容肾移植；与瑞典一样，所有患者术前均接受免疫吸附，但我们不是安排移植后预防性免疫吸附，而是仅在患者的同种凝集素滴度（IgG抗A或抗B）超过特定阈值时，才在术后对其进行免疫吸附。这些阈值在术后第一周分别大于1:8，在术后第二周分别大于1:16。
术前透析时间较短、供体A1/受体O血型组合以及高初始起始滴度被确定为术后免疫吸附的预测因素。
使用这种按需策略，我们的数据显示，基于滴度的方案可降低成本，且不会给患者带来额外风险。
