Hatakeyama S, Fujita T, Murakami R, Suzuki Y, Sugiyama N, Yamamoto H, Okamoto A, Imai A, Tobisawa Y, Yoneyama T, Mori K, Yoneyama T, Hashimoto Y, Koie T, Narumi S, Ohyama C
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Transplant Proc. 2014;46(2):445-8. doi: 10.1016/j.transproceed.2013.09.036.
The development of immunosuppressive techniques has helped overcome the ABO incompatibility barrier. However, the outcomes of ABO-incompatible (ABOi) kidney transplantation remain a controversial issue with the advent of the anti-CD20 chimeric antibody rituximab. Herein, we report the outcomes of ABOi kidney transplantation with low-dose rituximab.
Between June 2006 and April 2013, 42 patients underwent living-related kidney transplantation at our hospital. The patients were divided into 2 groups: ABO-compatible (ABOc; n = 29) and ABOi kidney transplants using low-dose rituximab (100 mg/m(2)) without splenectomy (n = 13). The basic immunosuppression regimen (calcineurin inhibitor [CNI], mycophenolate mofetil [MMF], and steroids) was the same for both groups, except for the use of rituximab and therapeutic apheresis in the ABOi group. We compared post-transplantation renal function, incidents of virus infection, episodes of rejection, and graft survival between the 2 groups.
In our hospital, 30% of recipients received ABOi kidney transplants. The estimated glomerular filtration rate (eGFR) did not differ between the groups. Rejection episodes confirmed by biopsy in the ABOc and ABOi groups were 8 (28%) and 4 (31%) patients (P = .833), acute antibody-mediated rejection was observed in 1 (3.5%) and 2 (15%) patients (P = .165), and virus infection was observed in 14 (48%) and 3 (23%) patients (P = .252), respectively. The 5-year patient survival rate was 100% in both groups, and the 5-year graft survival rates were 95% for ABOc and 100% for ABOi transplants (P = .527).
These results suggest that the outcomes of ABOi kidney transplantation with low-dose rituximab are similar to those of ABOc kidney transplantation. Further study is necessary to address the efficacy and safety of ABOi kidney transplantation.
免疫抑制技术的发展有助于克服ABO血型不相容障碍。然而，随着抗CD20嵌合抗体利妥昔单抗的出现，ABO血型不相容（ABOi）肾移植的结果仍然是一个有争议的问题。在此，我们报告低剂量利妥昔单抗用于ABOi肾移植的结果。
2006年6月至2013年4月期间，我院42例患者接受了亲属活体肾移植。患者分为2组：ABO血型相容（ABOc；n = 29）组和使用低剂量利妥昔单抗（100 mg/m²）且未行脾切除术的ABOi肾移植组（n = 13）。除ABOi组使用利妥昔单抗和治疗性血液成分单采外，两组的基本免疫抑制方案（钙调神经磷酸酶抑制剂[CNI]、霉酚酸酯[MMF]和类固醇）相同。我们比较了两组移植后的肾功能、病毒感染发生率、排斥反应发作情况及移植物存活率。
在我院，30%的受者接受了ABOi肾移植。两组间的估计肾小球滤过率（eGFR）无差异。ABOc组和ABOi组经活检证实的排斥反应发作患者分别为8例（28%）和4例（31%）（P = 0.833），观察到急性抗体介导的排斥反应患者分别为1例（3.5%）和2例（15%）（P = 0.165），病毒感染患者分别为14例（48%）和3例（23%）（P = 0.252）。两组的5年患者生存率均为100%，ABOc组的5年移植物存活率为95%，ABOi肾移植组为100%（P = 0.527）。
这些结果表明，低剂量利妥昔单抗用于ABOi肾移植的结果与ABOc肾移植相似。有必要进一步研究ABOi肾移植的疗效和安全性。
