初始血型抗体效价对ABO不相合肾移植的影响
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摘要
目的:探讨初始血型抗体效价水平对ABO血型不相合活体肾移植临床结局的影响。方法:本研究纳入2014年9月至2017年11月在四川大学华西医院接受ABO血型不相合活体肾移植的40对供、受者。根据受者初始ABO血型抗体效价水平,将纳入的受者分为两组:低抗体效价组(n=18例)和高抗体效价组(n=22例),比较两组供、受者的基线特征、血型抗体效价变化和肾移植临床结局。结果:两组受者中位随访时间20个月(3～42)。所有受者在移植后2周内血型抗体效价均不超过1∶16。低效价和高效价组受者1年移植肾及受者存活率分别为94. 4%vs 95. 5%和100%vs 100%(P均>0. 05),每组均有1例受者发生超急性排斥反应致移植肾失功。两组受者术后2年内的血清肌酐水平和估算的肾小球滤过率无显著差异,急性排斥反应、感染、血糖血脂代谢水平及伤口液化的发生率也没有显著差异。结论:初始血型抗体水平并不影响ABO血型不相合肾移植的临床结局。
Objective: To investigate the impact of initial anti-A/B antibody titer on clinical outcomes in ABOincompatible living donor kidney transplantation. Methodology: A series of forty ABO-incompatible living kidney transplant recipients between September 2014 to November 2017 in West China Hospital were included in this study.According to initial anti-A/B antibody titer,recipients were divided into low-antibody group( titer≤1 ∶ 16)( n = 18) and high-antibody group( n = 22)( titer > 1 ∶ 16). The baseline characteristics,change of antibody titer and clinical outcomes between both groups were compared. Results: The rebound of A/B antibody titer within 2 weeks after transplantation in all recipients was not more than 1 ∶ 16.The median follow-up time was 20( 3 ～ 42) months.There was no significant difference in the serum creatinine and e GFR of recipients in two years after transplantation between both groups( P>0. 05).The one-year graft and patient survival in low-antibody group and high-antibody group were 94. 4% vs 95. 5%,and 100% vs 100%,respectively( P>0. 05). And one patient suffered from graft loss in each group because of hyperacute rejection. The incidence of rejection,infection,blood glucose and lipid metabolism,and the fatty liquefaction in wound were comparable between both groups( P > 0. 05). Conclusion: Our data suggests the initial anti-A/B antibody titer has no effect on outcomes of ABO-incompatible kidney transplantation.
Objective: To investigate the impact of initial anti-A/B antibody titer on clinical outcomes in ABOincompatible living donor kidney transplantation. Methodology: A series of forty ABO-incompatible living kidney transplant recipients between September 2014 to November 2017 in West China Hospital were included in this study.According to initial anti-A/B antibody titer,recipients were divided into low-antibody group( titer≤1 ∶ 16)( n = 18) and high-antibody group( n = 22)( titer > 1 ∶ 16). The baseline characteristics,change of antibody titer and clinical outcomes between both groups were compared. Results: The rebound of A/B antibody titer within 2 weeks after transplantation in all recipients was not more than 1 ∶ 16.The median follow-up time was 20( 3 ～ 42) months.There was no significant difference in the serum creatinine and e GFR of recipients in two years after transplantation between both groups( P>0. 05).The one-year graft and patient survival in low-antibody group and high-antibody group were 94. 4% vs 95. 5%,and 100% vs 100%,respectively( P>0. 05). And one patient suffered from graft loss in each group because of hyperacute rejection. The incidence of rejection,infection,blood glucose and lipid metabolism,and the fatty liquefaction in wound were comparable between both groups( P > 0. 05). Conclusion: Our data suggests the initial anti-A/B antibody titer has no effect on outcomes of ABO-incompatible kidney transplantation.
引文
1 Zschiedrich S,Kramer-Zucker A,Jnigen B,et al.An update on ABOincompatible kidney transplantation. Transpl Int,2015,28(4):387-397.
2 Crew RJ,Ratner LE.ABO-incompatible kidney transplantation:current practice and the decade ahead.Curr Opin Organ Transplant,2010,15(4):526-530.
3 de Weerd AE,MGH B. ABO-Incompatible Kidney Transplant Outcomes:A Meta-Analysis. Clin J Am Soc Nephrol,2018,13(8):1234-1243.
4 Opelz G,Morath C,Süsal C,et al.Three-year outcomes following 1420ABO-incompatible living-donor kidney transplants performed after ABO antibody reduction:results from 101 centers. Transplantation,2015,99(2):400-404.
5 王显丁,邱阳,宋涂润,等.ABO血型不相容亲属活体肾移植的个体化预处理.中华器官移植杂志,2015,36(8):449-452.
6 王显丁,邱阳,宋涂润,等.ABO血型不相容亲属活体肾移植14例报告.中华器官移植杂志,2016,37(6):348-352.
7 王显丁,邱阳,吕远航,等.ABO血型不相容亲属活体肾移植的临床分析.中华器官移植杂志,2018,39(1):29-34.
8 Montgomery RA,Locke JE,King KE,et al. ABO incompatible renal transplantation:a paradigm ready for broad implementation.Transplantation,2009,87(8):1246-1255.
9 程震,季曙明.ABO血型不相容的肾移植.肾脏病与透析肾移植杂志,2007,16(1):85-88.
10 Flint SM,Walker RG,Hogan C,et al. Successful ABO-incompatible kidney transplantation with antibody removal and standard immunosuppression.Am J Transplant,2011,11(5):1016-1024.
11 Takahashi K,Saito K. ABO-incompatible kidney transplantation.Transplant Rev(Orlando),2013,27(1):1-8.
12 Aikawa A,Kawamura T,Shishido S,et al. ABO-incompatible livingdonor pediatric kidney transplantation in Japan.Clinics(Sao Paulo),2014,69 Suppl 1:22-27.
13 Okumi M,Toki D,Nozaki T,et al. ABO-Incompatible Living Kidney Transplants:Evolution of Outcomes and Immunosuppressive Management.Am J Transplant,2016,16(3):886-896.
14 Hattori M,Mieno M,Shishido S,et al. Outcomes of Pediatric ABOincompatible Living Kidney Transplantations From 2002 to 2015:An Analysis of the Japanese Kidney Transplant Registry.Transplantation,2018,102(11):1934-1942.
15 Thaiss F. ABO-incompatible kidney transplantation. Wien Klin Wochenschr,2009,121(7-8):227-229.
16 Koo TY,Yang J. Current progress in ABO-incompatible kidney transplantation.Kidney Res Clin Pract,2015,34(3):170-179.
17 Bentall A,R BAN,Braitch M,et al. Clinical outcomes with ABO antibody titer variability in a multicenter study of ABO-incompatible kidney transplantation in the United Kingdom. Transfusion,2016,56(11):2668-2679.
18 Kobayashi T,Saito K. A series of surveys on assay for anti-A/B antibody by Japanese ABO-incompatible Transplantation Committee.Xenotransplantation,2006,13(2):136-140.
19 Chung BH,Lim JU,Kim Y,et al. Impact of the baseline anti-A/B antibody titer on the clinical outcome in ABO-incompatible kidney transplantation.Nephron Clin Pract,2013,124(1-2):79-88.
20 Baek CH,Kim H,Yang WS,et al.Clinical significance of isoagglutinin titer with the current desensitization protocol in ABO-incompatible kidney transplantation.Nephrology(Carlton),2018.
2 Crew RJ,Ratner LE.ABO-incompatible kidney transplantation:current practice and the decade ahead.Curr Opin Organ Transplant,2010,15(4):526-530.
3 de Weerd AE,MGH B. ABO-Incompatible Kidney Transplant Outcomes:A Meta-Analysis. Clin J Am Soc Nephrol,2018,13(8):1234-1243.
4 Opelz G,Morath C,Süsal C,et al.Three-year outcomes following 1420ABO-incompatible living-donor kidney transplants performed after ABO antibody reduction:results from 101 centers. Transplantation,2015,99(2):400-404.
5 王显丁,邱阳,宋涂润,等.ABO血型不相容亲属活体肾移植的个体化预处理.中华器官移植杂志,2015,36(8):449-452.
6 王显丁,邱阳,宋涂润,等.ABO血型不相容亲属活体肾移植14例报告.中华器官移植杂志,2016,37(6):348-352.
7 王显丁,邱阳,吕远航,等.ABO血型不相容亲属活体肾移植的临床分析.中华器官移植杂志,2018,39(1):29-34.
8 Montgomery RA,Locke JE,King KE,et al. ABO incompatible renal transplantation:a paradigm ready for broad implementation.Transplantation,2009,87(8):1246-1255.
9 程震,季曙明.ABO血型不相容的肾移植.肾脏病与透析肾移植杂志,2007,16(1):85-88.
10 Flint SM,Walker RG,Hogan C,et al. Successful ABO-incompatible kidney transplantation with antibody removal and standard immunosuppression.Am J Transplant,2011,11(5):1016-1024.
11 Takahashi K,Saito K. ABO-incompatible kidney transplantation.Transplant Rev(Orlando),2013,27(1):1-8.
12 Aikawa A,Kawamura T,Shishido S,et al. ABO-incompatible livingdonor pediatric kidney transplantation in Japan.Clinics(Sao Paulo),2014,69 Suppl 1:22-27.
13 Okumi M,Toki D,Nozaki T,et al. ABO-Incompatible Living Kidney Transplants:Evolution of Outcomes and Immunosuppressive Management.Am J Transplant,2016,16(3):886-896.
14 Hattori M,Mieno M,Shishido S,et al. Outcomes of Pediatric ABOincompatible Living Kidney Transplantations From 2002 to 2015:An Analysis of the Japanese Kidney Transplant Registry.Transplantation,2018,102(11):1934-1942.
15 Thaiss F. ABO-incompatible kidney transplantation. Wien Klin Wochenschr,2009,121(7-8):227-229.
16 Koo TY,Yang J. Current progress in ABO-incompatible kidney transplantation.Kidney Res Clin Pract,2015,34(3):170-179.
17 Bentall A,R BAN,Braitch M,et al. Clinical outcomes with ABO antibody titer variability in a multicenter study of ABO-incompatible kidney transplantation in the United Kingdom. Transfusion,2016,56(11):2668-2679.
18 Kobayashi T,Saito K. A series of surveys on assay for anti-A/B antibody by Japanese ABO-incompatible Transplantation Committee.Xenotransplantation,2006,13(2):136-140.
19 Chung BH,Lim JU,Kim Y,et al. Impact of the baseline anti-A/B antibody titer on the clinical outcome in ABO-incompatible kidney transplantation.Nephron Clin Pract,2013,124(1-2):79-88.
20 Baek CH,Kim H,Yang WS,et al.Clinical significance of isoagglutinin titer with the current desensitization protocol in ABO-incompatible kidney transplantation.Nephrology(Carlton),2018.