Ray Deepak Shankar, Thukral Sharmila
Department of Renal Sciences, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health Multispecialty Hospitals, Kolkata, India.
Am J Case Rep. 2017 Oct 6;18:1073-1076. doi: 10.12659/ajcr.905633.
BACKGROUND Even though renal transplantation across blood groups is not uncommonly practiced nowadays, there is still hesitation regarding ABO-incompatible transplantation with very high baseline antibody titer. In this case report, the outcome of an ABO-incompatible kidney transplant recipient with a high baseline isoagglutinin titer is reported. CASE REPORT The patient was a non-diabetic, 33-year-old man with end-stage renal disease secondary to chronic glomerulonephritis. The only kidney donor available was his mother, who was blood-group incompatible. The patient's blood group was O positive, whereas his mother was B positive. We evaluated him for an ABO-incompatible renal transplant. The baseline anti-B isoagglutinin titer was >1:8196. With a desensitization protocol of low-dose Rituximab, plasmapheresis, and IVIG, this titer was brought down to 1:32 before transplantation. He successfully underwent renal transplantation across the ABO barrier, and maintains good graft function after 1 year of follow-up. CONCLUSIONS In the present era, a high baseline isoagglutinin titer is no longer a contraindication for successful kidney transplantation in ABO-incompatible recipient-donor pairs.
背景 尽管如今血型不相容的肾移植已并非罕见，但对于基线抗体滴度非常高的ABO血型不相容移植仍存在犹豫。在本病例报告中，报道了一名基线血型凝集素滴度高的ABO血型不相容肾移植受者的结局。病例报告 患者为一名33岁非糖尿病男性，因慢性肾小球肾炎继发终末期肾病。唯一可用的肾脏供体是他的母亲，血型不相容。患者血型为O型阳性，而他的母亲为B型阳性。我们对他进行了ABO血型不相容肾移植评估。基线抗B血型凝集素滴度>1:8196。通过低剂量利妥昔单抗、血浆置换和静脉注射免疫球蛋白的脱敏方案，该滴度在移植前降至1:32。他成功地进行了跨越ABO屏障的肾移植，随访1年后移植肾功能良好。结论 在当今时代，基线血型凝集素滴度高不再是ABO血型不相容供受者对成功进行肾移植的禁忌证。
