Application of plasma with same blood group as kidney donor to preconditioning of ABO incompatible kidney transplantation
10.3760/cma.j.cn421203-20220411-00068
- VernacularTitle:ABO血型不相容肾移植中高抗体滴度O型受者采用供者同型血浆预处理的初步探索
- Author:
Shuai DAI
1
;
Min WANG
;
Yanan JING
;
Man FANG
;
Xiaohong GUAN
;
Zhiyong TANG
;
Keru WANG
;
Hongtao LIU
Author Information
1. 中国科学技术大学附属第一医院（安徽省立医院）肾移植科，合肥 230036
- Keywords:
Kidney transplantation;
ABO-incompatible renal transplantation;
Plasma exchange;
Comparative study
- From:
Chinese Journal of Organ Transplantation
2022;43(7):385-389
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the feasibility of applying plasma with same blood group as kidney donor to ABO incompatible kidney transplantation(ABOi-KT)preconditioning of blood group O recipients with high-titer anti-A/B preformed antibody(IgM/IgG titer ≥1∶256).Methods:A total of 15 cases of blood group O ABOi-KT recipients with high-titer anti-A/B were recruited and divided into two groups of AB( n=8)and kidney donor's blood(KD, n=7)according to plasma type for plasma exchange during preconditioning phase. Clinical data of preconditioning and post-KT were recorded. Results:They received plasmapheresis(PP)(8.1±2.5)sessions in preconditioning phase, including double plasma filtration(DFPP)(4.0±1.4)sessions and plasma exchange(PE)(4.1±2.0)sessions, PP frequency was(0.8±0.1)sessions per day. No hemolysis reaction occurred during preconditioning phase. Anti-A/B titers declined as expected and fulfilled the ABOi-KT criteria(IgM/IgG titers ≤1∶8). KT was performed successfully without antibody-mediated rejection. All of them survived with normal renal function within 90 days post-KT. Levels of serum creatinine at Day 7/30/90 post-KT were(92.9±30.4), (96.2±25.9)and(103.1±28.4)μmol/L; anti-A/B IgM titers at Day 7/30/90 post-KT 1∶1-1∶32, 1∶1-1∶64 and 1∶1-1∶32; anti-A/B IgG titers at Day 7/30/90 post-KT 1∶1-1∶64, 1∶1-1∶64 and 1∶1-1∶32 respectively. No significant differences existed in count/frequency of PP sessions, levels of serum creatinine or anti-A/B titers at each observation point between AB and KD groups( P>0.05). Conclusions:Plasma with the same blood group as kidney donor is feasible for maximizing the intensity of ABOi-KT preconditioning. Favorable outcomes may be achieved through an intensified desensitization strategy on blood group O recipients with high-titer anti-A/B preformed antibody. The potential risks and long-term outcomes should be further explored.
