Aeschbacher B, Wiedmer W, Stuck A, Gaenger K H, Frey F J, Nydegger U E
Schweiz Med Wochenschr. 1987 May 9;117(19):716-22.
AB0-incompatible kidney transplantation involves major risk of early acute vascular rejection. We report for the first time the successful preparation for renal homografting of a recipient of an HLA-haplotype identical, AB0 blood group B-incompatible renal homograft from a living related donor by immunoadsorption for removal of B blood group antibodies at days -4, -2 and -1. The iso-agglutinin anti-B titer was 1:256 before and 1:8 after three adsorption sessions in extracorporeal circuit. Before and after transplantation the splenectomized recipient was given azathioprine, prednisone and cyclosporine A. After homografting the anti-B iso-agglutinin and the anti-B isoimmune titers were mostly below 1:8 and never exceeded 1:32 and 1:64 respectively. 111 days after transplantation the recipient had a creatinine concentration in plasma of 160-180 mumol/l and was free of infectious complications. Thus the introduction of specific and convenient immunoadsorption of blood group antibodies by pheresis for preparation of renal homograft recipients may in future extend the indications for kidney transplantation in AB0-incompatible subjects, who have so far been denied the benefit of a living renal homograft.
ABO血型不相容的肾移植存在早期急性血管排斥的重大风险。我们首次报告了一名接受者成功接受肾移植的准备情况，该接受者与一名活体亲属供体的HLA单倍型相同、ABO血型不相容（B血型不相容）的肾移植物，通过免疫吸附在第-4天、-2天和-1天去除B血型抗体。体外循环中进行三次吸附后，同种凝集素抗B滴度从之前的1:256降至1:8。移植前后，脾切除的接受者接受了硫唑嘌呤、泼尼松和环孢素A治疗。移植后，抗B同种凝集素和抗B同种免疫滴度大多低于1:8，分别从未超过1:32和1:64。移植111天后，接受者血浆肌酐浓度为160 - 180μmol/L，无感染并发症。因此，通过血液成分单采进行血型抗体的特异性和便捷免疫吸附，为肾移植受者做准备，未来可能会扩大ABO血型不相容受试者的肾移植适应症，这些受试者迄今一直无法从活体肾移植中获益。
