Clinical and basical research for blood group ABO-incompatible kidney transplantation.

本文报告2例ABO血型不合的肾移植病例。例1（受者O型，供者A型）经脾切除和免疫吸附治疗后，抗A抗体IgM滴度降至x2^3，IgG降至x2^5。但因HLA抗原相关T细胞交叉配型阳性而不能移植。在情况2中（接收者：O型血，供者：A型血），采用脾切除、免疫吸附血浆置换和血浆置换可使抗A抗体滴度分别降至IgM的x2^6和IgG的x2^5。如此高的滴度不足以安全地进行移植。用流式细胞仪检测抗A抗体，并将其分离为IgM和IgG。与HLA相关的MLR和CML反应性高，而与抗原相关的MRLR反应性低。这些结果表明它们的抗原具有不同的免疫原性。两例均检测到抗RBC的ADCC，但仅例1检测到抗HLA的ADCC，且T细胞Cx阳性。在形成针对HAL和/或AB抗原的抗体的情况下，移植物将通过补体和/或ADCC的活化而受损。考虑到MLR和CML的反应性变化，而不会因DST而形成抗体。我们推测细胞免疫首先增强，然后产生抗体。然而，抗AB抗原的天然抗体（IgM）和致敏抗体（IgG）总是在没有细胞免疫激活的情况下产生。

We planed 2 cases of ABO incompatible kidney transplantation In case 1 (recipient:blood type O, donor:blood type A) The titers of anti a antibody were reduced to x2^3 in IgM and x2^5 in IgG after splencetomy and immunoadsorption procedures for serial 3 days. However the patient could not be transplanted because of positive T cell crossmatch related with HLA antigen. In case 2 (recipient: blood type O, donor:blood type A), the titer of anti a antibody could be reduced to x2^6 in IgM and x2^5 in IgG with splenectomy, immnoadsorption plasma pheresis and plasma exchange. Such these high titers were not enough to do transplantation safely. Anti A antibody was able to be detected and separated into IgM and IgG with flowcytometry. Their reactivities of MLR and CML related with HLA were high but MRLR(Mixed red blood cell and lymphocyte culture reaction) related with a antigen were low. These results showed the different immunoresctivity between their antigens. ADCC against RBC was detected in both cases but ADCC against HLA was in only case 1 with positive T cell Cx. Under formation of antibodies against HAL and/or AB antigens, graft will be damaged by activation of complements and/or ADCC. Considering the change of reactivities of MLR and CML without antibody formation due to DST. we suspected that cellular immunity will be firstly augmented, and then antibodies will be produced. However natural antibody(IgM) and sensitized antibody(IgG) against AB antigens are always produced without activation of cellular immunity.