Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Transplant Rev (Orlando). 2013 Jan;27(1):1-8. doi: 10.1016/j.trre.2012.07.003. Epub 2012 Aug 15.
Owing to the shortage of deceased donors in Japan, since 1989, we have performed ABO-incompatible kidney transplantation (ABO-IKTx) to expand the indication for living donor kidney transplantation. During the past two decades, about 2000 ABO-IKTxs were performed. Since 2001 the success rate for these kidney transplants has reached 96% for 1-year, 91% for 5-year and 83% for 9-year graft survival, similar to outcomes of ABO-compatible kidney transplantation (ABO-CKTx). This dramatic improvement in results means that ABO-IKTx has become accepted as a therapeutic alternative for end-stage renal failure. Today ABO-IKTx accounts for approximately 30% of all living donor kidney transplantations performed in Japan. We have been making a lot of efforts to elucidate the mechanism of acute antibody-mediated rejection in ABOI-KTx in order to overcome the ABO barrier and to improve the outcome. From careful and precise clinical observations, proteomic analysis of ABO histo-blood group antigens in graft endothelial cells and deep insight into immunology and biology, we have reached the hypothesis that the structural difference of ABO histo-blood group antigens and de novo corresponding antibody production would be the key and keyhole of the development of acute AMR in ABOI-KTx. Preoperative desensitization therapy would be the best solution for the suppression of acute AMR and graft loss, which is now widespread and improves the outcome.
由于日本供体短缺，自 1989 年以来，我们已经进行了 ABO 不相容肾移植（ABO-IKTx）以扩大活体供肾移植的适应证。在过去的二十年中，大约进行了 2000 例 ABO-IKTx。自 2001 年以来，这些肾移植的成功率达到了 1 年时 96%、5 年时 91%和 9 年时 83%的移植物存活率，与 ABO 相容肾移植（ABO-CKTx）的结果相似。结果的显著改善意味着 ABO-IKTx 已成为治疗终末期肾衰竭的一种治疗选择。如今，ABO-IKTx 约占日本所有活体供肾移植的 30%。为了克服 ABO 障碍并改善结果，我们一直在努力阐明 ABOI-KTx 中急性抗体介导排斥反应的机制。通过仔细和精确的临床观察、移植内皮细胞中 ABO 组织血型抗原的蛋白质组学分析以及对免疫学和生物学的深入了解，我们提出了这样的假设，即 ABO 组织血型抗原的结构差异和新产生的相应抗体的产生将是 ABOI-KTx 中急性 AMR 发展的关键和关键。术前脱敏治疗将是抑制急性 AMR 和移植物丢失的最佳解决方案，目前已广泛应用并改善了结果。
