Hirai Toshihito, Ishida Hideki, Toki Daisuke, Miyauchi Yuuki, Kohei Naoki, Iida Shouichi, Tokita Daisuke, Shimizu Tomokazu, Shirakawa Hiroki, Omoto Kazuya, Tanabe Kazunari
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Ther Apher Dial. 2011 Feb;15(1):89-97. doi: 10.1111/j.1744-9987.2010.00856.x.
Recipients of spousal donor transplantation (SDT) have poorer histocompatibility and higher human leukocyte antigen (HLA) sensitization due to pregnancy than those receiving related donor transplantation (RDT). Thus, SDT carries a higher risk of acute rejection (AR). In our department, patients at a high immunological risk, such as those with ABO incompatibility and HLA sensitization, were considered for desensitization by double filtration plasmapheresis and preoperative administration of rituximab. In this study we compared the AR incidence rates between SDT and RDT according to their immunological risk. We performed RDT in 279 and SDT in 100 patients, a total of 379 cases, between 2000 and 2008; 48.7% of RDT and 67.0% of SDT cases were considered to be at a high immunological risk and underwent preoperative desensitization (P=0.002). Even though the AR incident rate of SDT was higher than RDT in the low immunological risk group, in which the patients had undergone transplantation without desensitization (RDT 24.4%, SDT 37.0%, P=0.012), there was no significant difference between the two donor type groups in the high immunological risk group, in which transplantation with desensitization occurred (RDT 21.3%, SDT 31.3%, P>0.05). Preoperative administration of rituximab significantly reduced AR from 37.4% to 10.6% (P<0.001), especially T-cell mediated rejection (36.4% to 20.2%, P=0.01). SDT no longer carries a high risk when appropriate desensitization, including the use of rituximab, is performed. Overall, the five-year graft survival rates were similar between RDT and SDT.
与接受亲属供体移植（RDT）的患者相比，配偶供体移植（SDT）的受者由于妊娠而具有较差的组织相容性和更高的人类白细胞抗原（HLA）致敏性。因此，SDT发生急性排斥反应（AR）的风险更高。在我们科室，对于具有高免疫风险的患者，如ABO血型不相容和HLA致敏的患者，考虑通过双重滤过血浆置换和术前给予利妥昔单抗进行脱敏治疗。在本研究中，我们根据免疫风险比较了SDT和RDT之间的AR发生率。2000年至2008年间，我们对279例患者进行了RDT，对100例患者进行了SDT，共379例；48.7%的RDT病例和67.0%的SDT病例被认为具有高免疫风险并接受了术前脱敏治疗（P = 0.002）。即使在低免疫风险组中，SDT的AR发生率高于RDT，该组患者未进行脱敏治疗就接受了移植（RDT为24.4%，SDT为37.0%，P = 0.012），但在进行了脱敏治疗的高免疫风险组中，两种供体类型组之间没有显著差异（RDT为21.3%，SDT为31.3%，P>0.05）。术前给予利妥昔单抗可使AR从37.4%显著降低至10.6%（P<0.001），尤其是T细胞介导的排斥反应（从36.4%降至20.2%，P = 0.01）。当进行包括使用利妥昔单抗在内的适当脱敏治疗时，SDT不再具有高风险。总体而言，RDT和SDT的五年移植物存活率相似。
