Альманах клинической медицины. 2017; 45: 535-546
Несовместимые по группе крови родственные трансплантации почки: отдаленные результаты
https://doi.org/10.18786/2072-0505-2017-45-7-535-546Аннотация
Актуальность. Трансплантация почки от несовместимого по группе крови родственного донора – один из способов эффективного использования ресурса прижизненного донорства. В России данная технология применяется более 10 лет, однако сообщения об отдаленных результатах трансплантаций в настоящее время отсутствуют. Цель – изучить непосредственные и отдаленные результаты AB0-несовместимых трансплантаций почки от родственного донора. Материал и методы. Проанализированы результаты 49 последовательно выполненных AB0-несовместимых трансплантаций в период с 2011 по 2017 г. Предоперационная подготовка реципиента включала в себя введение ритуксимаба и внутривенного иммуноглобулина, сеансы плазмафереза и/или селективной иммуноадсорбции, комбинацию такролимуса, микофенолатов и глюкокортикостероидов. Целевой титр анти-A/B антител был равен 1:8. После трансплантации все реципиенты получали стандартную иммуносупрессивную терапию. Результаты. Исходный титр антигрупповых антител – иммуноглобулинов класса M составил 1:16 (1:2 – 1:1024), класса G – 1:4 (0 – 1:512), медиана использованной дозы ритуксимаба – 286 мг/м2 (94–396). Для достижения целевых значений титра антител требовалось до 10 сеансов плазмафереза и/или иммуноадсорбции (медиана – 2). За время наблюдения летальных исходов не было, утрачено 5 трансплантатов, один из них в результате сверхострого отторжения. Частота подтвержденного биопсией отторжения составила 6%. Одно-, трех- и шестилетняя выживаемость трансплантатов равнялась 94, 90 и 80% соответственно. Заключение. Преодоление барьера несовместимости по группе крови можно признать безопасной и эффективной стратегией в условиях дефицита донорских органов.
Список литературы
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2. Murray JE, Merrill JP, Dammin GJ, Dealy JB Jr, Walter CW, Brooke MS, Wilson RE. Study on transplantation immunity after total body irradiation: clinical and experimental investigation. Surgery. 1960;48:272–84.
3. Starzl TE, Marchioro TL, Holmes JH, Hermann G, Brittain RS, Stonington OH, Talmage DW, Waddell WR. Renal homografts in patients with major donor-recipient blood group incompatibilities. Surgery. 1964;55:195–200.
4. Cook DJ, Graver B, Terasaki PI. ABO incompatibility in cadaver donor kidney allografts. Transplant Proc. 1987;19(6):4549–52.
5. Slapak M, Naik RB, Lee HA. Renal transplant in a patient with major donor-recipient blood group incompatibility: reversal of acute rejection by the use of modified plasmapheresis. Transplantation. 1981;31(1):4–7.
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Almanac of Clinical Medicine. 2017; 45: 535-546
AB0-incompatible living donor kidney transplantation: the long-term outcomes
https://doi.org/10.18786/2072-0505-2017-45-7-535-546Abstract
Background: AB0-incompatible kidney transplantation is one of the ways to effectively expand the pool of living donors. In Russia, this technology has been used for more than 10 years, but until now there have been no reports on its long-term results. Aim: To evaluate the short- and long-term outcomes of the living-related AB0-incompatible kidney transplantations. Materials and methods: We analyzed the results of 49 consecutive AB0-incompatible kidney transplantations, performed from 2011 to 2017. Preoperative management of recipients included administration of rituximab and intravenous immunoglobulin, plasmapheresis and/or selective immunoadsorption, and combination of tacrolimus, mycophenolates and steroids. The target of anti-A/B antibody levels were is 1:8. All patients received standard immunosuppression after transplantation. Results: At baseline, median anti-A/B titer was 1:16 (1:2 to 1:1024) for IgM and 1:4 (0 to 1:512) for IgG. Median rituximab dose was 286 mg/m2 (range, from 94 to 396). To achieve target antibody levels, up to 10 plasmapheresis and/or immunoadsorption sessions (median, 2) were required. There were no deaths during the follow-up. Five grafts were lost, one of them due to hyperacute rejection. The incidence of biopsy-proven rejection was 6%. One-, three and six-year graft survival was 94%, 90% and 80%, respectively. Conclusion: Kidney transplantation across the AB0-incompatibility barrier is a safe, successful and reasonable option to reduce the organ shortage.
References
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