Kawagishi Naoki, Takeda Ikuo, Miyagi Shigehito, Satoh Kazushige, Akamatsu Yorihiro, Sekiguchi Satoshi, Fujimori Keisei, Sato Toshinobu, Satomi Susumu
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Ther Apher Dial. 2007 Oct;11(5):319-24. doi: 10.1111/j.1744-9987.2007.00506.x.
In this study, we report on the indications and efficacy of the elimination of antiallogeneic antibodies in living donor liver transplant recipients. Seven patients incompatible with the ABO-blood type were subjected to apheresis before transplantation. The procedure resulted in titers being decreased to less than a score of 8. After transplantation, apheresis was also performed in 6 cases and continuous hemodiafiltration in 1 case. In addition, three out of 11 ABO-blood type incompatible recipients were administered anti-CD20 antibody (rituximab). Two crossmatch positive patients were subjected to apheresis before transplantation, and in these cases the titers were reduced to less than a score of 2. Moreover, these two patients had no acute rejections after transplantation. We concluded that apheresis is effective for preventing acute rejection induced by pre-existing anti-A and/or anti-B antibodies, as well as antidonor specific antibodies, but is not effective in some patients who had accelerated humoral rejection.
在本研究中，我们报告了活体肝移植受者清除同种异体抗体的指征及疗效。7例ABO血型不相容的患者在移植前进行了血液成分单采术。该操作使抗体滴度降至8分以下。移植后，6例患者进行了血液成分单采术，1例患者进行了持续性血液透析滤过。此外，11例ABO血型不相容的受者中有3例接受了抗CD20抗体（利妥昔单抗）治疗。2例交叉配型阳性患者在移植前进行了血液成分单采术，在这些病例中，抗体滴度降至2分以下。此外，这2例患者移植后未发生急性排斥反应。我们得出结论，血液成分单采术对于预防由预先存在的抗A和/或抗B抗体以及抗供者特异性抗体引起的急性排斥反应是有效的，但对一些发生加速性体液排斥反应的患者无效。
