혈장교환술과 항-CD20 단클론항체 투여 후 시행한 ABO 부적합 신장 이식 1예 경험
An Experience of ABO-incompatible Kidney Transplantation Using Plasmapheresis and Anti-CD20 Monoclonal Antibody
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뇌사자 장기의 심각한 부족으로 인해 일본의 많은 기관에서는 혈장교환술, 비장적출술 및 면역억제제 요법을 병행하여 ABO 부적합 신장 이식을 성공적으로 시행하였다. 최근에는 항 CD20 단클론성 항체(rituximab)와 면역흡착법을 사용하는 방법이 유 럽에서 사용되고 있으나 한국에서는 거의 시행되고 있지 않다. 저자들은 혈장교환술과 rituximab을 사용한 후 ABO 부적합 신장 이식을 성공적으로 시행하여 경험을 보고하는 바이다. 환 자는 32세 여자로 만성신부전을 앓고 있었으며, 혈액형은 O형, Rh+였다. 공여자는 남편으로서 혈액형이 B, Rh+였다. 이식 2주 전 rituximab 투여, 이식 전 10일부터 2일 간격으로 5회의 혈 장교환술 및 정맥 내 감마글로불린 투여와 면역억제 요법을 병 행하여 환자의 항-A 및 항-B 항체를 각각 1:2, 1:1까지 성공적 으로 감소시켰고 신장 이식은 초급성 및 급성 거부반응 증후 없 이 성공적으로 시행되었다.
Abstract
Due to an extreme shortage of cadaveric kidneys, many centers in Japan successfully performed ABO-incompatible kidney transplantations using plasmapheresis, splenectomy and immunosuppression. Recently, a protocol including anti-CD20 monoclonal antibody (rituximab) and antigen-selective immunoadsorption has been used for ABO-incompatible transplantation in Europe. In Korea, ABO-incompatible kidney transplantation has been rarely performed. We report an experience of successful ABO-incompatible kidney transplantation using plasmapheresis and rituximab. The patient was a 32-yr-old female suffering from chronic renal failure, and her blood type was O, Rh+. The donor was her husband, and his blood type was B, Rh+. A combination therapy including 5 times of plasmapheresis starting from 10 days before transplantation with 2-day interval, intravenous gammaglobulin, rituximab at 2 weeks before transplantation and potent immunosuppression successfully decreased the titers of anti-A and anti-B antibodies to 1:2 and 1:1, respectively. The kidney transplantation was successful without any sign of hyperacute or acute rejection.
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