Geyer M, Fischer K-G, Drognitz O, Walz G, Pisarski P, Wilpert J
University Hospital Freiburg, Freiburg, Germany.
Contrib Nephrol. 2009;162:47-60. doi: 10.1159/000170812. Epub 2008 Oct 31.
Several protocols have been developed to effectively overcome the blood group barrier in renal transplantation. In the evolution of these protocols, one of the latest steps was the combination of anti-CD20 treatment with antigen-specific immunoadsorptions. Over the last years we have learned that these relatively new protocols carry very promising short-term and intermediate-term results which compare favorably to the outcome of ABO-compatible living donor transplantations. Latest reports suggest that combining immunoadsorptions with rituximab does not result in an increased risk of infectious complications or tumors in the first years after transplantation compared to ABO-compatible living donor transplantations. We recently demonstrated that a majority of patients with isoagglutinin titers >1:128 can be safely transplanted using rituximab and immunoadsorptions without an added risk of early antibody-mediated rejections. We have also shown that a cost saving 'on-demand strategy' of postoperative immunoadsorptions based on careful titer monitoring can be used as an alternative to preemptively scheduled immunoadsorptions. Although rituximab and antigen-specific immunoadsorptions are significantly less invasive than splenectomy and plasma-pheresis, long-term follow-up of patients treated with a combination of anti-CD20 antibody and antigen-specific immunoadsorption will be needed to benchmark this therapeutic option in relation to more established protocols.
已经开发出几种方案来有效克服肾移植中的血型屏障。在这些方案的发展过程中,最新的步骤之一是将抗CD20治疗与抗原特异性免疫吸附相结合。在过去几年中,我们了解到这些相对较新的方案具有非常有前景的短期和中期结果,与ABO相容的活体供体移植结果相比具有优势。最新报告表明,与ABO相容的活体供体移植相比,将免疫吸附与利妥昔单抗联合使用在移植后的头几年不会增加感染并发症或肿瘤的风险。我们最近证明,大多数同种凝集素滴度>1:128的患者可以使用利妥昔单抗和免疫吸附进行安全移植,而不会增加早期抗体介导的排斥反应风险。我们还表明,基于仔细的滴度监测的术后免疫吸附的成本节约型“按需策略”可以用作预先安排的免疫吸附的替代方案。尽管利妥昔单抗和抗原特异性免疫吸附的侵入性明显低于脾切除术和血浆置换术,但仍需要对接受抗CD20抗体和抗原特异性免疫吸附联合治疗的患者进行长期随访,以便将这种治疗选择与更成熟的方案进行比较。