仅口服免疫抑制剂行预处理的ABO血型不相容亲属活体肾移植的临床效果

ABO-incompatible renal transplantation pretreated with oralimmunosuppressants alone:a report of 16 cases

目的对于初始血型抗体效价≤1∶8的ABO血型不相容(ABOi)肾移植受者,探讨采用仅口服免疫抑制剂进行预处理的有效性和安全性。方法纳入2014年9月至2019年10月仅口服免疫抑制剂进行预处理的ABOi肾移植16例,以同期接受ABO血型相容(ABOc)肾移植32例作为对照,观察和比较两组受者情况。结果16例ABOi肾移植中,AB供A型4例,AB供B型3例,A供B型1例,B供A型4例,A供O型2例,B供O型2例。初始和移植当天受者ABO血型抗体效价(IgM和IgG)均≤1∶8。中位随访时间495 d(90~1696 d),ABOi组发生超急性排斥反应致移植肾切除1例,ABOi组和ABOc组移植肾存活率分别为93.75%(15/16)和100%(32/32),无受者死亡;两组受者术后6个月后血肌酐分别为(114.30±28.13)和(106.08±23.80)μmol/L(P=0.38),eGFR分别为(64.93±19.60)和(82.34±22.58)ml/min/1.73 m2(P=0.13);两组术后发生感染3例和5例,术后发生急性排斥反应3例和5例,两组感染和排斥反应发生率的差异均无统计学意义(P>0.05)。结论对于初始血型抗体效价≤1∶8的ABOi受者仅采用口服免疫抑制剂进行预处理是安全、可行的,这将极大简化此类受者术前的预处理方案,并减少术后并发症。

Objective To explore the efficacy and safety of pretreating with oral immunosuppressants alone for ABO-incompatible(ABOi)renal transplant recipients with an initial isoagglutinin titer<1:8.Methods From September 2014 to October 2019,16 cases of ABOi renal transplantation pretreated with oral immunosuppressants alone and 32 cases of ABO-compatible(ABOc)renal transplantation were recruited for comparing the inter-group incidence of graft function,acute rejection,infection and recipient and allograft survival.Results The 16 ABOi renal transplantations were AB-to-A(n=4),AB-to-B(n=3),A-to-B(n=1),B-to-A(n=4),A-to-O(n=2)and B-to-O(n=2).The initial isoagglutinin titer(IgM&IgG)and that on the date of transplantation were both≤1∶8.The median follow-up period was 495(90-1696)days.One patient in ABOi group underwent allograft nephrectomy due to hyperacute rejection.The graft survival rates were 93.75%(15/16)and 100%(32/32)in ABOi and ABOc groups respectively.No recipient died.No significant inter-group difference existed in postoperative renal function after 6 months(serum creatinineμmol/L:114.30±28.13 vs.106.08±23.80,P=0.38;eGFR ml/min/1.73 m2:64.93±19.60 vs.82.34±22.58,P=0.13).In ABOi group,there were 3 episodes of postoperative infection,2 episodes of acute rejection within 2 weeks(including 1 episode of hyperacute rejection)and 1 episode of acute rejection after 2 weeks;5 episodes of postoperative infection,no acute rejection within 2 weeks and 5 episodes of acute rejection after 2 weeks in ABOc group.No significant inter-group difference existed in the incidence of infection or rejection(P>0.05).Conclusions Using oral immunosuppressant alone is both safe and feasible for ABOi renal transplantation recipients with an initial isoagglutinin titer≤1∶8.It may greatly simplify the pretreatment scheme for those with a low initial isoagglutinin titer and lower the incidence of complications.