Montgomery Robert A, Locke Jayme E, King Karen E, Segev Dorry L, Warren Daniel S, Kraus Edward S, Cooper Matthew, Simpkins Christopher E, Singer Andrew L, Stewart Zoe A, Melancon J Keith, Ratner Lloyd, Zachary Andrea A, Haas Mark
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Transplantation. 2009 Apr 27;87(8):1246-55. doi: 10.1097/TP.0b013e31819f2024.
The requirements for potent immunosuppression coupled with the formidable risk of irreversible antibody-mediated rejection (AMR) have thus far limited the expansion of ABO incompatible (ABOi) kidney transplantation. We present a retrospective review of our single-center experience with 60 consecutive ABOi kidney transplants and describe the evolution of our treatment protocol to one that consists only of a brief escalation in immunosuppression without long-term B-cell suppression from splenectomy or anti-CD20. The 1-, 3-, and 5-year graft survival rates for the cohort were 98.3%, 92.9%, and 88.7%, respectively, which is comparable with United Network for Organ Sharing data for compatible live donor transplants. No instances of hyperacute rejection were observed, and no grafts were lost secondary to AMR. In fact, fewer than 15% of the patients experienced a clinical episode of AMR, and rejections were mild. Elimination of B-cell ablative therapies did not result in an increased incidence of AMR. Excellent graft function persists with a current median creatinine clearance of 60 mL/min. The findings of this study and the relatively simple therapeutic regimen used should facilitate widespread application of ABOi kidney transplantation resulting in one of the most rapid escalations in access to organs in the modern era of kidney transplantation.
强效免疫抑制的需求，加之不可逆转的抗体介导排斥反应（AMR）的巨大风险，迄今为止限制了ABO血型不相容（ABOi）肾移植的推广。我们对本中心连续60例ABOi肾移植的经验进行了回顾性分析，并描述了我们的治疗方案如何演变为仅包括短期强化免疫抑制，而无需通过脾切除术或抗CD20进行长期B细胞抑制的方案。该队列的1年、3年和5年移植肾存活率分别为98.3%、92.9%和88.7%，与器官共享联合网络中相容性活体供肾移植的数据相当。未观察到超急性排斥反应的病例，也没有移植肾因AMR而丢失。事实上，不到15%的患者经历过AMR临床发作，且排斥反应较轻。消除B细胞清除疗法并未导致AMR发生率增加。目前中位肌酐清除率为60 mL/min，移植肾功能良好。本研究的结果以及所采用的相对简单的治疗方案，应有助于ABOi肾移植的广泛应用，从而在现代肾移植时代实现器官可及性的最快速提升之一。
