Genberg Helena, Kumlien Gunilla, Wennberg Lars, Berg Ulla, Tydén Gunnar
Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden.
Transplantation. 2008 Jun 27;85(12):1745-54. doi: 10.1097/TP.0b013e3181726849.
In 2001 a protocol for ABO-incompatible (ABOi) kidney transplantation based on antigen-specific immunoadsorption and rituximab was introduced at our center, short-term results being comparable with those of ABO-compatible (ABOc) living donor kidney transplantation. Of greater importance, however, is long-term graft function, thus far not evaluated. The aim of this study was therefore to assess long-term results of this protocol.
Twenty ABOi kidney recipients with more than 12-month follow-up were included in the study: all adult crossmatch negative ABOi kidney recipients (n=15) were compared with an adult ABOc living donor recipient control group (n=30), and all pediatric ABOi kidney recipients (<16 years of age) (n=5) were compared with a group of pediatric ABOc kidney recipients (n=18).
Mean follow-up was three years. There was no significant difference in patient survival, nor in graft survival or in the incidence of acute rejection in any of the groups. In the adult kidney recipients mean glomerular filtration rate was equivalent at all time points (79-83 mL/min), as was Deltas-creatinine. In the pediatric groups, Deltas-creatinine was similar but glomerular filtration rate lower among the ABOi kidney recipients. There was a significant reduction (P<0.0001) without rebound in A/B antibody titers after transplantation (median IgG 1:2 and median IgM 1:1>1 year posttransplant) compared with pretransplant levels (median IgG 1:32 and IgM 1:16).
We conclude that ABOi kidney transplantation using antigen-specific immunoadsorption and rituximab is equivalent to ABOc living donor kidney transplantation. ABOi transplantation after this protocol does not have a negative impact on long-term graft function.
2001年，我们中心引入了一项基于抗原特异性免疫吸附和利妥昔单抗的ABO血型不相容（ABOi）肾移植方案，短期结果与ABO血型相容（ABOc）活体供肾移植相当。然而，更重要的是长期移植肾功能，目前尚未进行评估。因此，本研究的目的是评估该方案的长期结果。
本研究纳入了20例随访时间超过12个月的ABOi肾移植受者：将所有成年交叉配型阴性的ABOi肾移植受者（n = 15）与成年ABOc活体供肾移植受者对照组（n = 30）进行比较，将所有儿科ABOi肾移植受者（<16岁）（n = 5）与一组儿科ABOc肾移植受者（n = 18）进行比较。
平均随访时间为三年。各组在患者生存率、移植肾生存率或急性排斥反应发生率方面均无显著差异。在成年肾移植受者中，各时间点的平均肾小球滤过率相当（79 - 83 mL/分钟），血清肌酐变化值（Deltas-creatinine）也是如此。在儿科组中，ABOi肾移植受者的血清肌酐变化值相似，但肾小球滤过率较低。与移植前水平（IgG中位数1:32，IgM中位数1:16）相比，移植后A/B抗体滴度显著降低（P<0.0001）且无反弹（移植后1年以上IgG中位数1:2，IgM中位数1:1）。
我们得出结论，使用抗原特异性免疫吸附和利妥昔单抗的ABOi肾移植等同于ABOc活体供肾移植。按照该方案进行的ABOi移植对长期移植肾功能没有负面影响。
