Role of Plasma Exchange in ABO-incompatible Kidney Transplantation
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Background: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. Methods: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured. Results: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients,but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. Conclusions: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.
Abstract
Background: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. Methods: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured. Results: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients,but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. Conclusions: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.
참고문헌 (18)
- KONOS 2009 annual report, In Korean Network for Organ Sharing, "KONOS", ~ (2009)
- Szczepiorkowski ZM, "Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis", J Clin Apher, 25, pp.83~177 (2010)
- Starzl TE, "Splenectomy and thymectomy in human renal homotransplantation", Proc Soc Exp Biol Med, 113, pp.929~932 (1963)
- Ishida H, "Anti-AB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation", Transplantation, 70, pp.681~685 (2000)
- Huh KH, "Options for successful renal transplantation in recipients with incompatible living donors: Severance Hospital experience", Clin Transpl, pp.323~326 (2010)
- Roback JD, "Technical manual. 17th ed", pp.907~911 (2011), American Association of Blood Banks
- Levey AS, "Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values", Clin Chem, 53, pp.766~772 (2007)
- Kim SI, "Favorable outcomes among recipients of living-donor nephrectomy using video-assisted minilaparotomy", TRANSPLANTATION, 77(15), pp.1725~1728
- Hur M, "ABO-incompatible kidney transplantation, In Understanding the complexities of kidney transplantation", pp.332~348 (2011), InTech
- Kong JM, "ABO blood group incompatible living donor kidney transplantation without splenectomy", J Korean Soc Transplant, 23, pp.71~76 (2009)
- 문희원, "혈장교환술과 항-CD20 단클론항체 투여 후 시행한 ABO 부적합 신장 이식 1예 경험", Annals of Laboratory Medicine, 29(6), pp.585~588 (2009), 대한진단검사의학회
- Hellegering J, "Poor early graft function impairs long-term outcome in living donor kidney transplantation.", World J Urol (2012)
- Fidler ME, "Histologic findings of antibody-mediated rejection in ABO blood-groupincompatible living-donor kidney transplantation", Am J Transplant, 4, pp.101~107 (2004)
- Gloor JM, "A Comparison of splenectomy versus intensive posttransplant antidonor blood group antibody monitoring without splenectomy in ABO-incompatible kidney transplantation", Transplantation, 80, pp.1572~1577 (2005)
- Toki D, "Acute antibody-mediated rejection in living ABO-incompatible kidney transplantation: long-term impact and risk factors", Am J Transplant, 9, pp.567~577 (2009)
- Derksen R, "The efficacy of plasma exchange in the removal of plasma components", J Lab Clin Med, 104, pp.346~354 (1984)
- Winters JL, "Plasma exchange conditioning for ABO-incompatible renal transplantation", J Clin Apher, 19, pp.79~85 (2004)
- Madore F, "Therapeutic plasma exchange in renal diseases", J Am Soc Nephrol, 7, pp.367~386 (1996)