Lam Susanna, Hultin Sebastian, Preston John, Campbell Scott
Department of Renal Transplantation, Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia.
Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia.
Case Rep Transplant. 2020 Jul 24;2020:7461052. doi: 10.1155/2020/7461052. eCollection 2020.
ABO-incompatible kidney transplantation has been successfully utilised in a deceased donor and living donor kidney transplantation to improve organ utilisation and decrease waiting times. We describe a case of a successful, unanticipated ABO-incompatible donation after cardiac death (DCD) kidney transplant in a patient who had a previous ABOi haematopoietic stem cell transplant (HSCT) and had reverted to his original blood group B, after matching as a blood group A recipient with a blood group A donor. The recipient was unsensitized with a cPRA which was 0% and no donor-specific antibodies and zero HLA mismatch. An urgent anti-A titre was 1 : 2. Given the low antibody titres, we proceeded to transplantation. The patient developed delayed graft function and required dialysis on postoperative day 1 and day 2. The creatinine fell spontaneously on day 5, with progressively increased urine output and stable graft function on discharge at day 6. Anti-A titres were 1 : 1 on serial postoperative measurements. There were no rejection episodes, and the patient has a functioning graft at 16 months posttransplant. We describe a rare case in which the blood group can change after stem cell transplant and should be checked. We also demonstrate that a DCD ABOi transplant in the context of low anti-A titres for a patient with previous ABOi stem cell transplant can be performed successfully with standard immunosuppression.
ABO血型不相容的肾移植已成功应用于尸体供肾和活体供肾移植，以提高器官利用率并缩短等待时间。我们描述了一例成功的、意外的心脏死亡后捐赠（DCD）肾移植的ABO血型不相容病例，该患者曾接受过ABOi造血干细胞移植（HSCT），在与一名A型供体匹配为A型受者后，血型恢复为原来的B型。受者无致敏，交叉配血反应阳性率（cPRA）为0%，无供体特异性抗体，HLA错配为零。紧急抗A效价为1∶2。鉴于抗体效价较低，我们进行了移植手术。患者出现移植肾功能延迟恢复，术后第1天和第2天需要透析。肌酐在第5天自发下降，尿量逐渐增加，第6天出院时移植肾功能稳定。术后连续测量抗A效价为1∶1。未发生排斥反应，患者在移植后16个月移植肾功能良好。我们描述了一例罕见病例，即干细胞移植后血型可能发生变化，应进行检查。我们还证明，对于既往有ABOi干细胞移植的患者，在抗A效价较低的情况下，采用标准免疫抑制方案可成功进行DCD ABOi移植。
