血型 O 受者与活体 ABO 不相容肾移植中早期移植物功能恶化相关。

Blood group O recipients associated with early graft deterioration in living ABO-incompatible kidney transplantation.

机构信息

Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.

出版信息

Transplantation. 2009 Nov 27;88(10):1186-93. doi: 10.1097/TP.0b013e3181ba07ec.

DOI:10.1097/TP.0b013e3181ba07ec

PMID:19935372

Abstract

BACKGROUND

Blood group O individuals are known to have larger amounts of anti-ABO blood group (anti-A/B) IgG antibodies than A or B individuals. Therefore, in ABO-incompatible (ABOI) kidney transplantation (KTX), it is expected that blood group O recipients are more likely to suffer graft damage, because anti-A/B IgG antibodies are believed to be responsible for worse graft outcomes.

METHODS

This study assessed the graft outcomes between blood group O and non-O recipients in ABOI-KTX. A total of 164 consecutive recipients who underwent ABOI-KTX between 1990 and 2007 under three different immunosuppressive protocols were enrolled in this study. The study population was divided into two groups: (i) recipients with blood group O (n=87) and (ii) recipients with blood group A or B (non-O) (n=77).

RESULTS

High anti-A/B IgG titers were predominant in the O group (P<0.001), whereas no significant difference was observed in the IgM titers. The overall graft survival rate did not differ between the two groups; however, the 6-month graft survival rate was significantly lower in the O group (86% vs. 97%, P=0.011). Among 14 recipients who suffered graft loss within 6 months after transplantation, 12 (86%) were O recipients. The cumulative incidence of acute antibody-mediated rejection was significantly higher in the O group (60 days, 31 vs. 14%, P=0.013).

CONCLUSION

Our results may indicate that being a blood group O recipient is at great risk for experiencing early allograft deterioration, probably caused by anti-A/B IgG antibodies in ABOI-KTX.

摘要

背景

已知血型 O 个体比 A 型或 B 型个体具有更多的抗 ABO 血型（抗 A/B）IgG 抗体。因此，在 ABO 不相容（ABOI）肾移植（KTX）中，预计血型 O 受者更容易遭受移植物损伤，因为抗 A/B IgG 抗体被认为是导致更差移植物结局的原因。

方法

本研究评估了 ABOI-KTX 中血型 O 和非 O 受者的移植物结局。共纳入 1990 年至 2007 年间接受 ABOI-KTX 的 164 例连续受者，根据三种不同的免疫抑制方案进行研究。研究人群分为两组：（i）血型 O 受者（n=87）和（ii）血型 A 或 B（非 O）受者（n=77）。

结果

O 组中高抗 A/B IgG 滴度占优势（P<0.001），而 IgM 滴度无显著差异。两组总体移植物存活率无差异；然而，O 组 6 个月移植物存活率显著较低（86%对 97%，P=0.011）。在 14 例移植后 6 个月内发生移植物丢失的受者中，12 例（86%）为 O 型受者。O 组急性抗体介导排斥反应的累积发生率显著较高（60 天，31%对 14%，P=0.013）。