Renal transplantation across the ABO barrier using A2 kidneys.
Renal transplantation across the ABO barrier using A2 kidneys.
复制标题
使用 A2 肾跨越 ABO 屏障进行肾移植。
作者：
A. Alkhunaizi;A. M. Mattos;J. Barry;W. Bennett;D. Norman
背景
身体肾移植的等待名单持续增长，随着身体捐赠者的相对稀缺，1994年美国患者的等待时间中位数增加到824天。B型和O型血患者的中位等待时间分别为1329天和1007天。将A2血型肾脏(占A组的20%)分配给O型和B型患者，扩大了他们潜在的捐赠者池，并缩短了他们等待肾移植的时间。
方法
1991年5月至1998年6月，我们为6例O型血和9例B型血患者移植了15个A2肾。移植前检测抗-A等凝集素，抗-A1滴度和GT；或=1：8的患者接受血浆置换(PP)。
结果
1例高滴度抗A抗体患者，未接受PP治疗，因超急性排斥反应而失去同种异体移植。其余14名患者移植肾功能良好，1个月和1年的平均血肌酐水平分别为1.7(+/-0.89)mg/dl和1.3(+/-0.34)mg/dl。移植肾1年存活率为93.3+/-6.4%，患者存活率为100%。
结论
我们的结论是，为O型和B型受者分配A2血型肾脏是为这些移植候选者扩大供体池的一种切实可行的方法。PP对于降低抗A1和抗A2抗体水平和降低超急性排斥反应的风险可能是重要的。脾切除似乎是不必要的。
BACKGROUND
The waiting list for cadaveric kidney transplantation has continued to grow, and with the relative scarcity of cadaver donors, the median waiting time for patients in the United States increased to 824 days in 1994. The median waiting times for patients with blood groups B or O were 1329 and 1007 days, respectively. Allocation of blood group A2 kidneys (20% of group A) to blood group O and B patients expands their potential donor pool and shortens their waiting time for a kidney transplantation.
METHODS
Between May 1991 and June 1998, we transplanted 15 A2 kidneys into 6 blood group O and 9 blood group B patients. Anti-A isoagglutinins were measured before transplantation, and patients with anti-A1 titers > or = 1:8 underwent plasmapheresis (PP).
RESULTS
One patient with high titer anti-A antibodies, who did not receive PP, lost her allograft because of hyperacute rejection. Allograft function was excellent in the remaining 14 patients, with a mean serum creatinine level of 1.7 (+/-0.89) mg/dl at 1 month and 1.3 (+/-0.34) mg/dl at 1 year. The actuarial 1-year graft survival rate was 93.3+/-6.4% and the patient survival rate was 100%.
CONCLUSION
We conclude that the allocation of blood group A2 kidneys for blood group O and B recipients is a practical way to expand the donor pool for these transplant candidates. PP may be important for reducing the levels of anti-A1 and anti-A2 antibodies and for reducing the risk of hyperacute rejection. Splenectomy seems to be unnecessary.
影响因子：
158.5
作者：
TERASAKI, PI;CECKA, JM;TAKEMOTO, S
通讯作者：
TAKEMOTO, S