Improving access to kidney transplantation without decreasing graft survival:: Long-term outcomes of blood group A2/A2B deceased donor kidneys in B recipients
Improving access to kidney transplantation without decreasing graft survival:: Long-term outcomes of blood group A2/A2B deceased donor kidneys in B recipients
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DOI：
10.1097/01.tp.0000164288.82238.52
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发表时间：
2005-07-15
期刊：
影响因子：
6.2
通讯作者：
Warady, BA
中科院分区：
文献类型：
--
作者：
Bryan, CF;Winklhofer, FT;Warady, BA
背景将A（2）/A（2）B血型死亡供肾移植给B血型受者，可提高B血型受者的移植可及性。然而，这种做法是有争议的，缺乏长期数据。本研究分析了A（2）/A（2）B死亡供肾移植到选定的B受者体内的长期结局。我们回顾性评估了1994年至2003年期间使用分配系统将A（2）/A（2）B供体移植到抗A血型抗体滴度低的B受体的死亡供体肾的结局（移植物存活率、移植率和急性排斥反应）。患者接受常规免疫抑制治疗，无任何特异性抗体减少程序。我们进一步评估了该系统对血型移植的影响。在1,400例肾移植中，56例（4.0%）为A（2）/A（2）B至B受体。该系统减少了所有B受体的等待时间，甚至比A血型受体的等待时间更短（A（2）/A（2）B至B移植的中位等待时间=182天，而B至B移植的中位等待时间=297天; A至A移植的中位等待时间=307天）。尽管在A（2）/A（2）B-B移植中存在急性排斥反应增加的趋势，但无论供体类型如何，B受体的7年死亡删失移植物存活率均为72%。将A（2）/A（2）B死亡供体肾移植到B受体中，使得具有相似患者的血型之间的等待时间和使用常规免疫抑制的移植物存活率相等。该方案可能会导致B血型受者更平等地获得肾移植。
Background. The transplantation of blood group A(2)/A(2)B deceased donor kidneys into B recipients could improve access to transplantation for blood group B recipients. However, this practice is controversial, and long-term data are lacking. This study analyzed the long-term outcomes of A(2)/A(2)B deceased donor kidneys transplanted into selected B recipients.Methods. We retrospectively assessed the outcomes (graft survival, transplant rates, and acute rejection) of deceased-donor kidneys using an allocation system that transplanted A(2)/A(2)B donors into B recipients with low anti-A blood group antibody titers between 1994 and 2003. Patients received conventional immunosuppression without any specific antibody reduction procedures. We further assessed the impact this system had on access to transplantation by blood group.Results. Of 1,400 kidney transplants, 56 (4.0%) were A(2)/A(2)B to B recipients. The system reduced waiting time for all B recipients, even shorter than for blood group A recipients (median waiting times of A(2)/A(2)B to B transplants=182 days vs. B to B transplants=297 days; and A to A=307 days). Although there was a trend toward increased acute rejection in A(2)/A(2)B to B transplants, the actuarial 7-year death censored graft survival was 72% for B recipients regardless of donor type.Conclusions. Transplanting A(2)/A(2)B deceased donor kidneys into B recipients leads to an equalization of waiting time between blood groups with similar patient and graft survival using conventional immunosuppression. This protocol could lead to more equal access to kidney transplantation in blood group B recipients.