Ignjatović Ljiljana, Kovacević Zoran, Jovanović Dragan, Vavić Neven, Paunić Zoran, Radojević Milorad, Rabrenović Violeta, Obrencević Katarina, Mijusković Mirjana, Draskovic-Pavlović Biljana, Ostojić Gordana, Balint Bela, Bokonjić Dubravko
Military Medical Academy, Clinic of Nephrology, Department of Kidney Transplantation, Belgrade, Serbia.
Vojnosanit Pregl. 2009 Feb;66(2):117-22. doi: 10.2298/vsp0902117i.
BACKGROUND/AIM: Due to improved methods for removal of ABO isoagglutinins and novel immunosuppressive protocols, short and long-term outcome in blood group incompatible is similar to blood group compatible kidney transplantation. The aim of this study was to determine the efficacy of our original method for removal of ABO isoagglutinins from the blood in ABO-incompatible kidney allograft recipients.
Between 2006 and 2008 twelve patients were transplanted from ABO incompatible living donors. Titers of ABO isoagglutinins were 4-128 (IgG). Immunosuppressive therapy started 14 days before kidney transplantation with rituximab, followed by a triple therapy (prednisone + tacrolimus + mycophenolate mofetil) and the first plasma exchange (PE) procedure, in which one plasma volume was substituted with albumin and saline on day 7 before transplantation. For selective extracorporeal immunoadsorption, the removed plasma was mixed with donor blood type filtered red blood cells, centrifuged and the supernatant separated and preserved. In the next PE procedure, the removed plasma was replaced with immunoadsorbed plasma, and so on. Titers of ABO agglutinins, renal allograft function and survival were followed-up.
The pre-transplant treatment consisting of 1-5 PE procedures and immunosuppressive therapy resulted in target ABO agglutinins titers below 4. During a 10-24 month follow-up three patients had an early acute rejection, one patient acute rejection and hemolytic anemia, two patients surgical complications and one of them lost his graft. In the post-transplant period, the titers of ABO antibodies remained below 4. All the patients had stable kidney allograft function with mean serum creatinine +/- SD of 129 +/- 45 micromol/l at the end of the study.
Our method for removal of ABO antibodies was effective in a limited series of patients and short-term follow-up.
背景/目的：由于ABO血型同种凝集素去除方法的改进以及新型免疫抑制方案的出现，血型不相容肾移植的短期和长期结果与血型相容肾移植相似。本研究的目的是确定我们原创的从血型不相容肾移植受者血液中去除ABO血型同种凝集素方法的疗效。
2006年至2008年期间，12例患者接受了来自ABO血型不相容活体供者的肾移植。ABO血型同种凝集素滴度为4 - 128（IgG）。肾移植前14天开始免疫抑制治疗，使用利妥昔单抗，随后进行三联疗法（泼尼松 + 他克莫司 + 霉酚酸酯）以及首次血浆置换（PE），在移植前7天用白蛋白和生理盐水置换一个血浆量。对于选择性体外免疫吸附，将去除的血浆与供者血型过滤后的红细胞混合，离心后分离并保存上清液。在下一次PE过程中，用免疫吸附后的血浆替代去除的血浆，依此类推。对ABO凝集素滴度、肾移植功能和存活情况进行随访。
移植前由1 - 5次PE过程和免疫抑制治疗组成的预处理使目标ABO凝集素滴度低于4。在10 - 24个月的随访期间，3例患者发生早期急性排斥反应，1例患者发生急性排斥反应和溶血性贫血，2例患者出现手术并发症，其中1例失去了移植肾。移植后，ABO抗体滴度保持在4以下。所有患者的移植肾功能稳定，研究结束时平均血清肌酐±标准差为129±45微摩尔/升。
我们去除ABO抗体的方法在有限数量的患者和短期随访中是有效的。
