Department of Nephrology, Royal Melbourne Hospital, Australia Department of Haematology, Royal Melbourne Hospital, Australia.
Am J Transplant. 2011 May;11(5):1016-24. doi: 10.1111/j.1600-6143.2011.03464.x. Epub 2011 Mar 30.
ABO-incompatible (ABOi) kidney transplantation is an established therapy, though its implementation to date has been in part limited by the requirement for additional immunosuppression. Here, we describe the outcomes of 37 patients undergoing ABOi kidney transplantation utilizing perioperative antibody depletion and receiving an identical tacrolimus-based immunosuppressive regimen to contemporaneous ABO-compatible (ABOc) recipients, with the exception that mycophenolate was commenced earlier (7-14 days pretransplant). Antibody depletion was scheduled according to baseline anti-ABO antibody titer (tube IAT method: median 1:128, range 1:8 to 1:4096). Patient and graft survival for the 37 ABOi recipients was 100% after a median 26 months (interquartile range [IQR] 18-32). Eight rejection episodes (two antibody-mediated and six cellular) in ABOi recipients were successfully treated with biopsy-proven resolution. Latest median eGFR is 50 mL/min × 1.73 m² (IQR 40-64) for ABOi patients and 54 mL/min × 1.73 m² (IQR 44-66) in the ABOc patients (p = 0.25). We conclude that ABOi transplantation can be performed successfully with perioperative antibody removal and conventional immunosuppression. This suggests that access to ABOi transplantation can include a broader range of end-stage kidney disease patients.
ABO 不相容（ABOi）肾移植是一种已确立的治疗方法，但迄今为止，其实施部分受到需要额外免疫抑制的限制。在这里，我们描述了 37 例接受 ABOi 肾移植的患者的结果，这些患者在围手术期接受了抗体耗竭，并接受了与同期 ABO 相容（ABOc）受者相同的他克莫司为基础的免疫抑制方案，除了霉酚酸酯更早开始（移植前 7-14 天）。根据基线抗 ABO 抗体滴度（试管 IAT 法：中位数 1:128，范围 1:8 至 1:4096）安排抗体耗竭。37 例 ABOi 受者的患者和移植物存活率在中位数 26 个月（四分位距 [IQR] 18-32）后为 100%。8 例 ABOi 受者的排斥反应（2 例抗体介导和 6 例细胞介导）经活检证实成功治疗。ABOi 患者的最新中位 eGFR 为 50 mL/min×1.73 m²（IQR 40-64），ABOc 患者为 54 mL/min×1.73 m²（IQR 44-66）（p=0.25）。我们得出结论，ABOi 移植可以通过围手术期抗体清除和常规免疫抑制成功进行。这表明可以让更多的终末期肾病患者获得 ABOi 移植的机会。
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