ABO血型不相容(ABOi)的亲属肾移植受体个体化预处理的探索

Individualized pretreatment of ABO-incompatible(ABOi) living donor kidney transplantation:a pilot study

目的探讨ABO血型不相容的亲属肾移植受体个体化预处理方案。方法以2016年4月至2019年4月复旦大学附属中山医院泌尿外科收治的10例ABO血型不相容亲属肾移植受体为研究对象。其中男性9例、女性1例;A型供O型5例,B型供O型3例,AB供A型1例,B型供A型1例;高血型抗体滴度受体(血型抗体滴度≥1∶128)6例,低血型抗体滴度受体(血型抗体滴度<1∶128)4例。采用利妥昔单抗(美罗华)+血浆置换的个体化预处理方案,并检测受体血型抗体滴度变化及其他化验指标。结果经个体化预处理后,所有受体术前血型抗体IgM、IgG滴度均可达到目标。高血型抗体滴度受体平均接受4.33次血浆置换,低血型抗体滴度受体平均接受1.25次血浆置换。应用利妥昔单抗后外周血CD19+细胞均明显下降至计数为0。预处理过程中,2例受体出现皮肤风疹团,约2~3天后自行消退;1例出现心衰,经积极治疗后改善,1例出现腹泻,其余受体无不良事件发生。随访至今10例受体一般情况均良好,移植肾功能稳定。结论即使存在高血型抗体滴度,ABO血型不相容亲属肾移植受体经强化血浆置换及采用利妥昔单抗的个体化预处理仍可获得良好的预后。

Objective To investigate the individualized pretreatment of kidney transplant recipients with ABO-incompatible(ABOi)recipients of living donor. Methods Ten patients with ABO-incompatible relatives were enrolled in Zhongshan Hospital from Apr.2016 to Apr.2019,including 9 males and 1 female.There were 5 cases A to O,3 cases B to O,1 case AB to A,and 1 case B to A.There were 6 high blood antibody titer(≥1∶128)recipients and 4 low blood antibody titer(<1∶128)recipients.The recipients got individual pretreatment(rituximab plus plasma exchange),and their changes of blood antibody titer and other indicators were detected after transplantation. Results The blood antibody IgM and IgG titers of the 10 recipients reached the target level before transplant surgeries.High titer recipients got 4.33 times of plasma exchange,while low titer recipients got 1.25 times in average. Peripheral blood CD19+cells were decreased to 0 after rituximab administration. During pretreatment,2 recipients got skin rashes and faded after 2-3 days,1 got heart failure and recovered after treatment,and 1 got diarrhea. The others had no postoperative adverse events.The 10 recipients showed good genernal condition and graft function during follow-up. Conclusions In ABOi kidney transplantation,individualized pretreatment protocols could be developed according to the recipient’s condition and result in good prognosis,even in recipients with high antibody titers.