Gang Sujin, Han Ahram, Min Sang-Il, Ha Jongwon, Yang Jaeseok
Departments of Surgery, Seoul National University Hospital, Seoul, Korea.
Departments of Transplantation Center, Seoul National University Hospital, Seoul, Korea.
Korean J Transplant. 2019 Dec 31;33(4):153-158. doi: 10.4285/jkstn.2019.33.4.153.
For successful human leukocyte antigen-incompatible (HLAi) or ABO-incompatible (ABOi) living-donor kidney transplantations (LDKTs), pretransplant desensitization is essential; however, early antibody-mediated rejection (ABMR) remains the most important complication after HLAi or ABOi transplantation. Here, we report a case of early acute ABMR in simultaneous HLAi and ABOi LDKT with preformed donor-specific antibody (DSA), despite desensitization. Dialysis-dependent, severe ABMR occurred with a rebound of pre-existing DSA and appearance of de novo DSA after initial normalization of renal function, 8 days postoperatively. However, a low anti-ABO antibody titer (1:8) was maintained after transplantation. Combination therapy of plasmapheresis, high-dose intravenous immunoglobulin, and bortezomib improved both ABMR and renal functions. Thus, an appropriate preventive and therapeutic management for early ABMR is important among high-risk LDKT patients. Furthermore, early AMBR can occur despite pretransplant desensitization as seen in this case, and close monitoring of the patient and prompt management are considered vital for better therapeutic outcomes.
对于成功进行人类白细胞抗原不相容（HLAi）或ABO血型不相容（ABOi）的活体供肾移植（LDKT）而言，移植前脱敏至关重要；然而，早期抗体介导的排斥反应（ABMR）仍然是HLAi或ABOi移植后最重要的并发症。在此，我们报告一例在同时进行HLAi和ABOi的LDKT中发生早期急性ABMR的病例，尽管进行了脱敏治疗，但仍存在预先形成的供者特异性抗体（DSA）。术后8天，在肾功能初步恢复正常后，依赖透析的严重ABMR伴随着预先存在的DSA反弹以及新生DSA的出现而发生。然而，移植后抗ABO抗体滴度维持在较低水平（1:8）。血浆置换、大剂量静脉注射免疫球蛋白和硼替佐米的联合治疗改善了ABMR和肾功能。因此，对于高危LDKT患者，对早期ABMR进行适当的预防和治疗管理非常重要。此外，如本病例所示，尽管进行了移植前脱敏，早期ABMR仍可能发生，对患者进行密切监测并及时处理被认为对获得更好的治疗效果至关重要。
