Ishikawa A, Itoh M, Ushlyama T, Suzuki K, Fujita K
Department of Urology, Hamamatsu University School of Medicine, Japan.
Clin Transplant. 1998 Apr;12(2):80-3.
We achieved success in ABO-incompatible renal allografting after removing anti-A and/or anti-B antibodies from the recipient's plasma using double filtration plasmapheresis (DFPP). We report here the results of our initial 2 cases. Case 1 was a 40-yr-old female whose blood group was A+. The donor was her younger brother, a 37-yr-old male, whose blood group was B+. The human lymphocyte antigens (HLAs) were one haplotype identical, and the stimulation index of the mixed lymphocyte culture (MLC-SI) was 34. Case 2 was a 28-yr-old male whose blood group was B+. The donor was his father, a 58-yr-old male, whose blood group was AB+. The HLAs were one-haplo-type identical as well, and the MLC-SI was 71. We carried out 4 sessions of DFPP pre-operatively; i.e. on days -6, -4, -2 and -1. 2.5 1 of plasma were treated with 500 ml of 4.4% plasma protein fraction in each procedure. The pre-operative target titer of anti-A/B antibody, measured by the saline tube test, was set at less than x 8. We also used 5 kinds of immunosuppressants. Cyclosporine was administered on day -2 beginning with 8 mg/kg/d, and its dose was modified according to the trough level. 500 mg of methylprednisolone were administered intravenously during the operation, and prednisolone was started on day 1 with 60 mg/d and tapered. Azathioprine was started on day -2 with 2 mg/kg/d for 7 d and 1 mg/kg/d thereafter. 5 mg/kg/d of gusperimus was given intravenously from day 0 for 5 d. 30 mg/kg/d of ALG was given intravenously from day 0 for 14 d. Along with these immunosuppressants, 0.1 mg/kg/h of nafamostat mesilate was administered intravenously from day 0 for 3 d, and 4 mg/kg/d of ticlopidine was given orally from day 3. X-Ray irradiation to the renal graft was not done. Following splenectomy standard renal allografting was performed. In Case 1, the titer of anti-B antibody was reduced from x 16 to x 4. In Case 2, the titer of anti-A antibody was reduced from x 32 to x 4. The post-operative courses of these 2 cases were satisfactory. Although our experience is limited, ABO incompatible kidney transplantation can safely be performed using DFPP.
我们通过双重滤过血浆置换术（DFPP）从受者血浆中去除抗A和/或抗B抗体，成功实现了ABO血型不相容肾移植。在此，我们报告最初2例患者的结果。病例1为一名40岁女性，血型为A+。供者是她37岁的弟弟，血型为B+。人类淋巴细胞抗原（HLA）有一个单倍型相同，混合淋巴细胞培养刺激指数（MLC - SI）为34。病例2为一名28岁男性，血型为B+。供者是他58岁的父亲，血型为AB+。HLA同样有一个单倍型相同，MLC - SI为71。我们在术前进行了4次DFPP治疗，即在第 - 6、 - 4、 - 2和 - 1天。每次治疗用500 ml 4.4%的血浆蛋白分离液处理2.5升血浆。术前通过盐水试管试验测定的抗A/B抗体目标滴度设定为小于8倍。我们还使用了5种免疫抑制剂。环孢素在第 - 2天开始给药，初始剂量为8 mg/kg/d，并根据血药谷浓度调整剂量。术中静脉注射500 mg甲泼尼龙，术后第1天开始口服泼尼松龙，起始剂量为60 mg/d，随后逐渐减量。硫唑嘌呤在第 - 2天开始给药，前7天剂量为2 mg/kg/d，之后为1 mg/kg/d。从第0天开始静脉注射5 mg/kg/d的古司他丁，共5天。从第0天开始静脉注射30 mg/kg/d的抗淋巴细胞球蛋白，共14天。除了这些免疫抑制剂，从第0天开始静脉注射0.1 mg/kg/h的甲磺酸萘莫司他，共3天，从第3天开始口服4 mg/kg/d的噻氯匹定。未对肾移植进行X线照射。行脾切除术后进行标准肾移植。在病例1中，抗B抗体滴度从16倍降至4倍。在病例2中，抗A抗体滴度从32倍降至4倍。这2例患者的术后病程均令人满意。尽管我们的经验有限，但使用DFPP可以安全地进行ABO血型不相容肾移植。
