Department of Renal Transplantation Surgery, Sapporo Hokuyu Hospital, Sapporo, Japan.
Clin Transplant. 2011 Jul;25 Suppl 23:19-22. doi: 10.1111/j.1399-0012.2011.01454.x.
A 21-yr-old man of blood type O receiving hemodialysis for IgA nephropathy underwent living-related ABO-incompatible (ABOI) renal transplantation from his mother, whose blood type is A. He was negative for flow cross-match, anti-human leukocyte antigen (HLA) antibody, and anti-MICA antibody. Pre-treatment anti-A IgG titer was 1:256. Desensitization consisted of tacrolimus, mycophenolate mofetil, methylprednisolone, rituximab, and plasmapheresis. He developed acute antibody rejection at day 2 post-transplant, which was successfully treated. After renal artery reconstruction surgery at day 91 for renovascular hypertension caused by renal artery stricture, the patient suffered from acute prostatitis, which subsequently induced type III acute antibody-mediated rejection. Even after recovery from the rejection after temporary hemodialysis, graft function progressively deteriorated and consecutive allograft biopsy showed progressive thrombotic microangiopathy (TMA) without any evidence of donor-specific antibody other than anti-A antibody. The tacrolimus dose was kept low for fear of tacrolimus-induced TMA. Despite these efforts, the patient resumed hemodialysis six months' post-transplant.
一位 21 岁、血型为 O 的男性因 IgA 肾病接受血液透析治疗，他与母亲进行了 ABO 血型不相容（ABOI）的活体亲属肾移植，母亲的血型为 A。他的血流交叉配型、抗人类白细胞抗原（HLA）抗体和抗 MICA 抗体均为阴性。预处理时抗 A IgG 效价为 1:256。脱敏治疗包括他克莫司、霉酚酸酯、甲基强的松龙、利妥昔单抗和血浆置换。移植后第 2 天发生急性抗体排斥反应，经治疗后成功缓解。第 91 天因肾动脉狭窄导致肾血管性高血压行肾动脉重建手术后，患者出现急性前列腺炎，随后引发 III 型急性抗体介导的排斥反应。尽管在临时血液透析后排斥反应得到缓解，但移植物功能逐渐恶化，连续的同种异体肾活检显示进行性血栓性微血管病（TMA），除抗 A 抗体外，没有任何供体特异性抗体的证据。由于担心他克莫司诱导 TMA，他克莫司的剂量保持较低。尽管采取了这些措施，患者在移植后 6 个月仍恢复血液透析。
