Transplant Surgery, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Ross 771B, Baltimore, MD 21205, USA.
Clin J Am Soc Nephrol. 2011 Aug;6(8):2041-6. doi: 10.2215/CJN.02940311. Epub 2011 Jul 22.
Use of incompatible kidney transplantation (IKT) is growing as a response to the organ shortage and the increase in sensitization among candidates. However, recent regulatory mandates possibly threaten IKT, and the potential effect of these mandates cannot be estimated because dissemination of this modality remains unknown. The goal of this study was to better understand practice patterns of IKT in the United States.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Directors from all 187 unique active adult kidney transplant programs were queried about transplantation across the following antibody barriers: positive Luminex, negative flow crossmatch (PLNF); positive flow, negative cytotoxic crossmatch (PFNC); positive cytotoxic crossmatch (PCC); and ABO incompatible (ABOi).
Responses from 125 centers represented 84% of the live-donor transplant volume in the United States. Barriers of PLNF, PFNC, PCC, and ABOi are being crossed in 70%, 51%, 18%, and 24%, respectively, of transplant centers that responded. Desensitization was performed in 58% of PLNF, 76% of PFNC, 100% of PCC, and 80% of ABOi using plasmapheresis and low-dose intravenous Ig (IVIg) in 71% to 83% and high-dose IVIg in 29% to 46%.
A higher proportion of centers perform IKT than might be inferred from the literature. The rapid dissemination of these protocols despite adequate evidence of a clear advantage of IKT transplants argues for the creation of a national registry and randomized studies.
为应对器官短缺和候选人群致敏率上升的问题，不合规肾移植（IKT）的应用日益增多。然而，最近的监管要求可能会威胁到 IKT，而由于这种模式的传播尚不清楚，因此无法估计这些要求的潜在影响。本研究旨在更好地了解美国 IKT 的实践模式。
设计、地点、参与者和测量：对所有 187 个独特的成人肾移植项目的主任进行了询问，了解以下抗体障碍下的移植情况：Luminex 阳性、流式细胞交叉配型阴性（PLNF）；流式细胞阳性、细胞毒性交叉配型阴性（PFNC）；细胞毒性交叉配型阳性（PCC）和 ABO 不相容（ABOi）。
来自 125 个中心的回应代表了美国活体供肾移植量的 84%。在做出回应的移植中心中，PLNF、PFNC、PCC 和 ABOi 的障碍分别有 70%、51%、18%和 24%被跨越。在 58%的 PLNF、76%的 PFNC、100%的 PCC 和 80%的 ABOi 中进行了脱敏，采用了血浆置换和低剂量静脉内免疫球蛋白（IVIg），比例为 71%至 83%，高剂量 IVIg 的比例为 29%至 46%。
与文献中的推断相比，进行 IKT 的中心比例更高。尽管有充分的证据表明 IKT 移植具有明显优势，但这些方案的迅速传播表明需要创建一个国家登记处和进行随机研究。
