Allen Geoff, Simpkins Christopher E, Segev Dorry, Warren Daniel, King Karen, Taube Janis, Locke Jayme, Baldwin William, Haas Mark, Chivukula Raghu, Montgomery Robert A
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Contrib Nephrol. 2009;162:35-46. doi: 10.1159/000170811. Epub 2008 Oct 31.
Successful ABO-incompatible (ABOi) kidney transplantation of non-A2 renal allografts requires preconditioning to reduce anti-blood group antibody to safe lev-els in order to avoid hyperacute rejection. Unfortunately, early post-transplant acute antibody-mediated rejection remains a problem in these patients and can result in rapid graft loss. A number of investigators have encountered ABOi recipients who have had no evidence of allograft injury in the setting of elevated titers of anti-ABO antibody, a protective phenomenon that has been termed 'accommodation'. Little is known about the time course of accommodation. We report a case of a successful ABOi renal transplant recipient who had evidence of accommodation within the first week following transplantation.
The patient is a 36-year-old, highly sensitized blood group.woman who underwent live donor transplantation from her human leukocyte antigen-identical blood group A1 brother following therapy with plasmapheresis and low-dose intravenous immunoglobulin for an initial anti-A anti-human globulin antibody titer of 512. Within the first week following transplantation, her anti-A titer rose to 128 without change in her renal function. At 1 month following transplantation, her anti-A titer had risen to 256 at which time a biopsy was per-formed that demonstrated no evidence of antibody-mediated rejection.
This patient demonstrates that accommodation of the renal allograft following ABOi transplantation may take place in the early postoperative period in the setting of high titer antibody. The implications for postoperative management of the ABOi patient and the need for future investigation in this area are discussed.
成功进行非A2肾移植的ABO血型不相容（ABOi）肾移植需要进行预处理，以将抗血型抗体降低到安全水平，从而避免超急性排斥反应。不幸的是，移植后早期急性抗体介导的排斥反应在这些患者中仍然是一个问题，并且可能导致移植肾迅速丢失。一些研究人员遇到过ABOi受者，他们在抗ABO抗体滴度升高的情况下没有移植肾损伤的证据，这种保护现象被称为“适应”。关于适应的时间进程知之甚少。我们报告了一例成功的ABOi肾移植受者的病例，该受者在移植后的第一周内就有适应的证据。
患者为一名36岁、高度致敏的血型女性，在接受血浆置换和低剂量静脉注射免疫球蛋白治疗后，其初始抗A抗人球蛋白抗体滴度为512，随后接受了来自其人类白细胞抗原相同的A1血型兄弟的活体供肾移植。在移植后的第一周内，她的抗A滴度升至128，而肾功能没有变化。移植后1个月，她的抗A滴度升至256，此时进行了活检，结果显示没有抗体介导的排斥反应的证据。
该患者表明，ABOi移植后肾移植的适应可能在术后早期高滴度抗体的情况下发生。讨论了ABOi患者术后管理的意义以及该领域未来研究的必要性。
