Rakpithayanon Chanyanuch, Mai-On Nattapakorn, Konwai Sirihatai, Wuttiputhanun Thunyatorn, Townamchai Natavudh, Sutherasan Methee, Opanuraks Julin, Avihingsanon Yingyos, Udomkarnjananun Suwasin
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkhla University, Songkhla, Thailand.
Am J Case Rep. 2025 Aug 1;26:e948529. doi: 10.12659/AJCR.948529.
BACKGROUND ABO-incompatible (ABOi) kidney transplantation has been performed for several years, with the understanding that elevated antibody titers against the donor blood group are associated with a heightened risk of antibody-mediated rejection. The primary strategy for managing ABOi transplantation involves desensitization through antibody removal and the administration of rituximab. Effective methods for antibody removal include plasmapheresis, double filtration plasmapheresis, and immunoadsorption, using specialized absorbent columns. CASE REPORT The patient was a 51-year-old woman with end-stage kidney disease who received an ABO-incompatible (B to O) kidney allograft from her husband. Her initial anti-B antibody titer was 1: 2048 (by gel column-agglutination). During the pre-conditioning phase, sessions of double filtration plasmapheresis (DFPP) combined with rituximab failed to reduce the anti-B antibody titer below 1: 512, and a bleeding complication occurred as a result of DFPP. Subsequently, a rescue approach involving specific anti-B antibody immunoadsorption was implemented, achieving an anti-B titer of 1: 32 on the day of the operation. The living donor kidney transplantation was performed successfully without significant complications. CONCLUSIONS We present the first case using immunoadsorption as a rescue therapy for DFPP-resistant anti-B titers prior to ABO-incompatible kidney transplantation. Among the available antibody removal protocols, immunoadsorption has demonstrated favorable outcomes. This technique can be performed over extended durations to accommodate larger plasma volumes while minimizing the risk of bleeding complications, making it an effective rescue strategy for cases that are resistant to traditional apheresis methods.
ABO血型不相容（ABOi）肾移植已开展数年，人们认识到针对供体血型的抗体滴度升高与抗体介导的排斥反应风险增加有关。管理ABOi移植的主要策略包括通过抗体清除和使用利妥昔单抗进行脱敏。有效的抗体清除方法包括血浆置换、双重滤过血浆置换以及使用专门的吸附柱进行免疫吸附。病例报告：患者为一名51岁的终末期肾病女性，接受了来自其丈夫的ABO血型不相容（B型到O型）肾移植。她最初的抗B抗体滴度为1:2048（凝胶柱凝集法）。在预处理阶段，双重滤过血浆置换（DFPP）联合利妥昔单抗未能将抗B抗体滴度降至1:512以下，并且由于DFPP出现了出血并发症。随后，实施了一种包括特异性抗B抗体免疫吸附的挽救方法，在手术当天抗B滴度达到了1:32。活体供肾移植成功进行，无明显并发症。结论：我们报告了首例在ABO血型不相容肾移植前使用免疫吸附作为对DFPP抵抗的抗B滴度的挽救疗法的病例。在现有的抗体清除方案中，免疫吸附已显示出良好的效果。该技术可以长时间进行以处理更大的血浆量，同时将出血并发症的风险降至最低，使其成为对传统血液分离方法有抵抗的病例的有效挽救策略。
