接受利妥昔单抗治疗的配偶供体来源的ABO血型不相容活体肾移植受者
ABO-Incompatible Living Kidney Transplant Recipients from Spousal Donors Receiving Rituximab.
作者信息
Uchida Junji, Iwai Tomoaki, Kabei Kazuya, Nishide Shunji, Yamasaki Takeshi, Kuwabara Nobuyuki, Naganuma Toshihide, Kumada Norihiko, Takemoto Yoshiaki, Nakatanti Tatsuya
机构信息
Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
出版信息
Urol Int. 2016;97(4):457-465. doi: 10.1159/000449014. Epub 2016 Oct 13.
INTRODUCTION
We summarized our experience with ABO-incompatible living kidney transplant recipients from spousal donors receiving rituximab.
PATIENTS AND METHODS
Between June 2006 and December 2014, 82 patients with end-stage renal disease underwent living donor kidney transplantation at Osaka City University Hospital, of which 23 cases were ABO-incompatible transplantation between spouses with rituximab induction. We analyzed these recipients, focusing on their immunosuppressive protocols, frequency of acute rejections, and patient/graft survivals.
RESULTS
Patient and graft survival rates were 100%. The incidence of acute cellular rejection (ACR) was 30.4%. One patient experienced antibody-mediated rejection (AMR) and intractable ACR, 2 had AMR, and 2 had intractable ACR episodes that were treated using thymoglobulin.
CONCLUSIONS
This study demonstrated that ABO-incompatible kidney transplantation between spouses using rituximab is a radical but effective treatment for end-stage renal disease. However, this procedure could be immunologically high risk due to ABO-incompatibility and poor histocompatibility.
引言
我们总结了接受利妥昔单抗的配偶活体供肾ABO血型不相容肾移植受者的经验。
患者与方法
2006年6月至2014年12月期间，82例终末期肾病患者在大阪市立大学医院接受了活体供肾移植，其中23例为配偶间ABO血型不相容移植并采用利妥昔单抗诱导治疗。我们对这些受者进行了分析，重点关注其免疫抑制方案、急性排斥反应的发生率以及患者/移植物存活率。
结果
患者和移植物存活率均为100%。急性细胞排斥反应（ACR）的发生率为30.4%。1例患者发生了抗体介导的排斥反应（AMR）和难治性ACR，2例发生了AMR，2例发生了难治性ACR发作，使用抗胸腺细胞球蛋白进行了治疗。
结论
本研究表明，配偶间使用利妥昔单抗进行ABO血型不相容肾移植是治疗终末期肾病的一种激进但有效的方法。然而，由于ABO血型不相容和组织相容性差，该手术在免疫方面可能具有较高风险。
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