Kenmochi T, Saigo K, Maruyama M, Akutsu N, Iwashita C, Otsuki K, Ito T, Suzuki A, Miyazaki M
Department of Surgery, Chiba-East National Hospital, National Hospital Organization, Chiba, Japan.
Transplant Proc. 2008 Sep;40(7):2289-91. doi: 10.1016/j.transproceed.2008.06.039.
ABO-incompatible kidney transplantation has become a popular alternative to kidney transplantation in Japan because of the severe shortage of cadaveric donors. In our institution, 21 cases of ABO-incompatible kidney transplantation were performed from April 2004, to October 2007. Recipient age was 42.8 +/- 14.5 years old; there were 9 men and 12 women. Duration of hemodialysis was 1,914 +/- 2,343 days. Donor operation was performed using a complete laparoscopic procedure. Recipient's splenectomy was performed using a hand-assisted laparoscopic procedure and kidney transplantation was performed with a standard method using an extraperitoneal approach. Pretransplant immunosuppressive protocol includes an administration of mycophenolate mofetil, tacrolimus, predonisolone, splenectomy, double filtration plasmapheresis (DFPP), and plasma exchange (PE). All patients showed an immediate graft function and their serum creatinine levels promptly decreased to 1.48 +/- 0.99 mg/dL on day 7 and 1.21 +/- 0.72 mg/dL on day 30. Both immunoglobulin (Ig)M and IgG titers were maintained at much lower levels for 7 days after transplantation in all patients. Cytomegalovirus antigenemia was observed in 11 patients (52.4%). One patient (4.8%) developed a Pneumocystis Carinii pneumonia and the formation of lymphocele was observed in one patient (4.8%). Total patient survival at 3 years was 95.2%, and graft survival at 3 years was 90.5%, which were almost equal to those in the patients who underwent ABO-matched, compatible kidney transplantation.
由于尸体供体严重短缺，ABO血型不相容肾移植在日本已成为肾移植的一种常用替代方法。在我们机构，2004年4月至2007年10月期间共进行了21例ABO血型不相容肾移植。受者年龄为42.8±14.5岁；男性9例，女性12例。血液透析时间为1914±2343天。供体手术采用完全腹腔镜手术。受者的脾切除术采用手辅助腹腔镜手术，肾移植采用标准的腹膜外入路方法。移植前免疫抑制方案包括给予霉酚酸酯、他克莫司、泼尼松龙、脾切除术、双重滤过血浆置换（DFPP）和血浆置换（PE）。所有患者术后移植肾立即发挥功能，术后第7天血清肌酐水平迅速降至1.48±0.99mg/dL，第30天降至1.21±0.72mg/dL。所有患者移植后7天内免疫球蛋白（Ig）M和IgG滴度均维持在低得多的水平。11例患者（52.4%）出现巨细胞病毒血症。1例患者（4.8%）发生卡氏肺孢子虫肺炎，1例患者（4.8%）观察到淋巴囊肿形成。3年时患者总生存率为95.2%，移植肾生存率为90.5%，这与接受ABO血型匹配、相容肾移植的患者几乎相等。
