ABO incompatible kidney transplantation --immunological aspect-.
ABO incompatible kidney transplantation --immunological aspect-.
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ABO 不相容肾移植——免疫学方面——。
DOI：
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发表时间：
2003
影响因子：
0.9
通讯作者：
A. Hasegawa
中科院分区：
文献类型：
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作者：
A. Aikawa;M. Yamashita;T. Hadano;T. Ohara;K. Arai;T. Kawamura;A. Hasegawa
ABO血型不合肾移植（ABOINCKT）在日本由于缺乏尸体供者而发展起来。我们在本中心进行了76例活体ABOINCKT。采用免疫吸附法或血浆置换法去除供者血型抗体。免疫抑制包括环孢霉素或他克莫司、类固醇、环磷酰胺或硫唑嘌呤或霉酚酸酯，最近还包括巴利昔单抗。脾切除术在移植手术中常规进行。供体血型抗原在移植后所有时间点和所有条件下的血管内皮上均强烈表达。红细胞凝集反应（RBAR）仅在1例迟发性超急性排斥反应患者的肾组织中呈阳性。在18例来自A1或B型供者的O型ABO INCKT受者中观察到供者特异性抗体抑制。预处理后检测ADCC活性。ABOINCKT的急性体液排斥反应可由ADCC引起，也可由抗原抗体反应引起。从1989年6月至1996年12月，37例ABOINCKT受者的5年移植物和患者存活率分别为75%和64%，但自1997年1月以来，39例ABOINCKT受者的5年移植物和患者存活率均为100%。ABOINCKT在血型抗原和抗体共存的情况下产生了适应性。目前，ABOINCKT是一种应考虑的替代方案，特别是对于等待尸体移植时间较长的O型血患者和儿科患者。
ABO incompatible kidney transplantation (ABOINCKT) has been developed in Japan because of the shortage of cadaveric donors. We have performed 76 living-donor ABOINCKT in our center. Donor blood type antibody was removed by immunoadsorption or plasmapheresis and exchange. Immunosuppression consisted of cyclosporine or tacrolimus, steroid, and cyclophosphamide or azathioprine or mycophenolate mofetil and, recently, basiliximab. Splenectomy was routinely performed during the transplantation surgery. Donor blood type antigen was strongly expressed on the vascular endothelium at all time points and in all conditions posttransplantation. Red blood cell agglutination reaction (RBAR) was positive only in renal tissues from a patient with delayed hyperacute rejection. Donor specific antibody suppression was observed in 18 ABOINCKT recipients with blood type O from a donor with blood type A1 or B. ADCC activity was detected after pre-treatment. Acute humoral rejection in ABOINCKT can result from ADCC, as well as by antigen-antibody reaction. Five year graft and patient survival rates were 75% and 64% in 37 ABOINCKT recipients from June 1989 through December 1996, however they have been 100% in 39 ABOINCKT recipients since January 1997. Accommodation has been produced in ABOINCKT with the co-existence of blood type antigen and antibody. Currently, ABOINCKT is an alternative which should be considered, particularly for blood type O patients with extended waits for cadaveric transplantation and for pediatric patients.