Prasad Narayan, Chellapan Anand, Srivastava Anis, Bhadauria Dharmendra, Kaul Anupama, Patel Manas, Gupta Amit
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Nephrol. 2022 Jan-Feb;32(1):82-86. doi: 10.4103/ijn.IJN_64_20. Epub 2022 Jan 5.
A repeat renal transplantation is believed to confer the best survival advantage for allograft failure. The scarcity of matching donors at one end, coupled with the expanding pool of ABO-incompatible (ABOi) donors at the other end, lead us to consider the option of ABOi kidney re-transplantation. However, ABOi kidney re-transplantation is associated with heightened immunological risk due to the presence of two substantial immunological barriers. Concern, queries, and uncertainty exist over the course and outcome of this option. We prospectively studied five patients who underwent live-related ABOi re-transplantation after a failed previous transplant. Four patients (mean age 40.8 ± 6.6 years, 4 males) underwent a second renal transplant, whereas one patient had a third renal transplant. All patients received desensitization with rituximab, plasmapheresis, and intravenous immunoglobulin as per routine protocol. One patient required immunoadsorption to achieve the desired Anti-ABO titer. All five patients had good graft survival. One of them developed combined antibody and cell-mediated rejection and another antibody-mediated rejection. Live-related ABOi kidney re-transplantation could be a viable option for patients with a previously failed graft.
再次肾移植被认为对移植肾失功具有最佳的生存优势。一方面供体匹配者稀缺，另一方面ABO血型不相容（ABOi）供体库不断扩大，这促使我们考虑ABOi肾再次移植这一选择。然而，由于存在两大免疫屏障，ABOi肾再次移植伴随着更高的免疫风险。对于这一选择的过程和结果存在担忧、疑问和不确定性。我们前瞻性地研究了5例先前移植失败后接受亲属活体ABOi再次移植的患者。4例患者（平均年龄40.8±6.6岁，4例男性）接受了第二次肾移植，而1例患者接受了第三次肾移植。所有患者均按照常规方案接受利妥昔单抗、血浆置换和静脉注射免疫球蛋白脱敏治疗。1例患者需要进行免疫吸附以达到所需的抗ABO滴度。所有5例患者移植肾存活良好。其中1例发生了抗体和细胞介导的混合性排斥反应，另1例发生了抗体介导的排斥反应。亲属活体ABOi肾再次移植对于先前移植失败的患者可能是一个可行的选择。
