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首页> 外文期刊>Transplant international : >Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy
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Living donor kidney transplantation in crossmatch-positive patients enabled by peritransplant immunoadsorption and anti-CD20 therapy

机译：交叉配体阳性患者的活体供体肾脏移植通过移植周围免疫吸附和抗CD20治疗得以实现

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摘要

Living donor kidney transplantation in crossmatch-positive patients is a challenge that requires specific measures. Ten patients with positive crossmatch results (n = 9) or negative crossmatch results but strong donor-specific antibodies (DSA; n = 1) were desensitized using immunoadsorption (IA) and anti-CD20 antibody induction. IA was continued after transplantation and accompanied by HLA antibody monitoring and protocol biopsies. After a median of 10 IA treatments, all patients were desensitized successfully and transplanted. Median levels of mean fluorescence intensity (MFI) of Luminex-DSA before desensitization were 6203 and decreased after desensitization and immediately before transplantation to 891. Patients received a median of seven post-transplant IA treatments. At last visit, after a median follow-up of 19 months, 9 of 10 patients had a functioning allograft and a median Luminex-DSA of 149 MFI; serum creatinine was 1.6 mg/dl, and protein to creatinine ratio 0.1. Reversible acute antibody-mediated rejection was diagnosed in three patients. One allograft was lost after the second post-transplant year in a patient with catastrophic antiphospholipid syndrome. We describe a treatment algorithm for desensitization of living donor kidney transplant recipients that allows the rapid elimination of DSA with a low rate of side effects and results in good graft outcome.
机译：交叉配对阳性患者的活体供体肾脏移植是一项挑战，需要采取具体措施。使用免疫吸附（IA）和抗CD20抗体诱导使10名交叉匹配结果为阳性（n = 9）或阴性交叉匹配结果为阴性但强供体特异性抗体（DSA; n = 1）的患者脱敏。移植后继续进行IA，并伴有HLA抗体监测和方案活检。在平均接受10次IA治疗后，所有患者均成功脱敏并移植。脱敏前Luminex-DSA的平均荧光强度（MFI）中位数为6203，脱敏后和即将移植前降至891。患者接受了7种移植后IA治疗的中位数。在最后一次访视时，中位随访19个月后，每10例患者中有9例具有正常的同种异体移植功能，Luminex-DSA的中位值为149 MFI。血清肌酐为1.6 mg / dl，蛋白质与肌酐之比为0.1。在三名患者中诊断出可逆的急性抗体介导的排斥反应。患有灾难性抗磷脂综合症的患者在移植后第二年后失去了一个同种异体移植物。我们描述了一种对活体供体肾移植受体脱敏的治疗算法，该算法可快速消除DSA，且副作用率低，并导致良好的移植结果。

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