Rana D S, Bhalla A K, Gupta Ashwani, Malik Manish, Gupta Anurag
Nephrology, Sir Ganga Ram Hospital, New Delhi, IND.
Cureus. 2024 Jun 14;16(6):e62350. doi: 10.7759/cureus.62350. eCollection 2024 Jun.
Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD); however, ABO incompatibility (ABOi) poses challenges due to increased graft rejection risk. Desensitization strategies, including immunoadsorption (IA), aim to overcome ABOi barriers. The objective of this case report was to present the initial findings and patient outcomes of ABOi kidney transplantation (KT) using two different brands of IA columns (Glycosorb ABO and SECORIM-ABO) in reducing isoagglutinin titers to the desired target level. We present a case report of a 51-year-old male with ESRD secondary to diabetic kidney disease who underwent desensitization for ABOi KT, involving rituximab administration followed by IA using Glycosorb and Vitrosorb SECORIM-ABO columns and plasmapheresis (PP). Glycosorb ABO column decreased anti-B titers from an initial level of 1:128/1:128 to 1:64/1:64 (target range ≤1:8); however, the titers rebounded to 1:64 following the fourth session of PP. Subsequent use of Vitrosorb SECORIM-ABO column achieved target titers of 1:4, enabling successful transplantation with satisfactory graft function. Monitoring included anti-B IgG/IgM titer levels post IA columns, IA column reuse, kidney function, and adverse events. The IA columns were well tolerated. Desensitization using IA columns effectively reduced anti-B titers, facilitating successful ABOi KT.
肾移植是终末期肾病（ESRD）的首选治疗方法；然而，ABO血型不相容（ABOi）由于移植排斥风险增加而带来挑战。脱敏策略，包括免疫吸附（IA），旨在克服ABOi障碍。本病例报告的目的是展示使用两种不同品牌的IA柱（Glycosorb ABO和SECORIM - ABO）进行ABOi肾移植（KT）在将同种凝集素滴度降低至所需目标水平方面的初步发现和患者预后。我们报告一例51岁男性患者，患有糖尿病肾病继发的ESRD，接受了ABOi KT脱敏治疗，包括给予利妥昔单抗，随后使用Glycosorb和Vitrosorb SECORIM - ABO柱进行IA以及血浆置换（PP）。Glycosorb ABO柱将抗B滴度从初始水平1:128 / 1:128降至1:64 / 1:64（目标范围≤1:8）；然而，在第四次PP治疗后滴度反弹至1:64。随后使用Vitrosorb SECORIM - ABO柱达到了1:4的目标滴度，从而实现了成功移植且移植肾功能良好。监测包括IA柱治疗后抗B IgG/IgM滴度水平、IA柱再利用情况、肾功能和不良事件。IA柱耐受性良好。使用IA柱进行脱敏有效降低了抗B滴度，促进了ABOi KT的成功。
