NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK.
Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
Pediatr Nephrol. 2023 Feb;38(2):529-535. doi: 10.1007/s00467-022-05583-5. Epub 2022 Jun 13.
There is increasing evidence of good short-term and medium-term outcomes of ABO incompatible (ABOi) and HLA incompatible (HLAi) kidney transplantation with pre-transplant positive crossmatches in paediatric practice. However, there remain concerns regarding the higher risks of infective complications and antibody-mediated rejections. The aim of our study is to show longer-term follow-up on all ABOi and HLAi paediatric kidney transplant recipients (pKTR) in the UK.
Questionnaires specifying kidney transplant type, desensitisation requirement and kidney allograft function were sent to 13 paediatric nephrology centres that performed kidney transplantation in children and young people under 18 years of age who received an ABOi and/or HLAi transplant between 1 January 2006 and 31 December 2016. Patient and kidney allograft survival were compared between ABOi, HLAi and ABO/HLA compatible (ABOc/HLAc) groups.
Among 711 living donor kidney transplants performed in the UK, 23 were ABOi and 6 were HLAi. Patient survival was 87%, 100% and 96% in ABOi, HLAi and ABOc/HLAc groups, respectively, at median follow-up of 6.8 (3.6-14.0) years post-transplant. Death-censored kidney allograft survival was 100% in all 3 groups at last follow-up. There were no cases of primary non-function in ABOi or HLAi groups, but 2% in the ABOc/HLAc group. There was one reported case of Epstein-Barr viral-induced post-transplant lymphoproliferative disorder.
Longer term follow-up has shown that ABOi and HLAi kidney transplantation are feasible for pKTR where no compatible donors are available, and that minimising desensitisation should be achieved where possible. A higher resolution version of the Graphical abstract is available as Supplementary information.
越来越多的证据表明，在儿科实践中，对于预移植交叉配型阳性的 ABO 不相容（ABOi）和 HLA 不相容（HLAi）肾移植，其短期和中期结果良好。然而，对于感染性并发症和抗体介导的排斥反应风险较高的问题仍存在担忧。本研究的目的是展示英国所有 ABOi 和 HLAi 儿科肾移植受者（pKTR）的长期随访结果。
向在 2006 年 1 月 1 日至 2016 年 12 月 31 日期间为 18 岁以下儿童和青少年进行肾移植的 13 个儿科肾病中心发送了专门指定肾移植类型、脱敏要求和肾移植物功能的问卷。比较了 ABOi、HLAi 和 ABO/HLA 相容（ABOc/HLAc）组之间的患者和肾移植物存活率。
在英国进行的 711 例活体供肾移植中，23 例为 ABOi，6 例为 HLAi。在中位随访 6.8（3.6-14.0）年后，ABOi、HLAi 和 ABOc/HLAc 组患者存活率分别为 87%、100%和 96%。在最后一次随访时，所有 3 组的死亡为肾移植后censored 移植物存活率均为 100%。ABOi 或 HLAi 组均未发生原发性无功能，而 ABOc/HLAc 组有 2%。报告了 1 例 EBV 诱导的移植后淋巴组织增生性疾病。
更长时间的随访表明，对于没有合适供体的 pKTR，ABOi 和 HLAi 肾移植是可行的，在可能的情况下应尽量减少脱敏。可提供图文摘要的更高分辨率版本作为补充信息。
