Transplant outcomes of 100 cases of living-donor ABO-incompatible kidney transplantation  

作　　者：Saifu Yin Qiling Tan Youmin Yang Fan Zhang Turun Song Yu Fan Zhongli Huang Tao Lin Xianding Wang 

机构地区：[1]Department of Urology,Institute of Urology,Organ Transplantation Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China [2]The Third Comprehensive Care Unit,West China Hospital,West China School of Nursing,Sichuan University,Chengdu,Sichuan 610041,China.

出　　处：《Chinese Medical Journal》2022年第19期2303-2310,共8页中华医学杂志（英文版）

基　　金：National Natural Science Foundation of China(Nos.81870513,81600584);the Sichuan Science and Technology Program(No.2019YJ0133);the Chengdu Science and Technology Program(No.2019-YF05-00084-SN);1.3.5 Project for Disciplines of Excellence Clinical Research Incubation Project,West China Hospital,Sichuan University(Nos.2018HXFH049,ZY2016104,2021HXFH007)。

摘　　要：Background:Although ABO-incompatible(ABOi)kidney transplantation(KT)has been performed successfully,a standard preconditioning regimen has not been established.Based on the initial antidonor ABO antibody titers,an individualized preconditioning regimen is developed,and this study explored the efficacy and safety of the regimen.Methods:From September 1,2014,to September 1,2020,we performed 1668 consecutive living-donor KTs,including 100 ABOi and 1568 ABO-compatible(ABOc)KTs.ABOi KT recipients(KTRs)with a lower antibody titer(≤1:8)were administered oral immunosuppressive drugs(OIs)before KT,while patients with a medium titer(1:16)received OIs plus antibody-removal therapy(plasma exchange/double-filtration plasmapheresis),patients with a higher titer(≥1:32)were in addition received rituximab(Rit).Competing risk analyses were conducted to estimate the cumulative incidence of infection,acute rejection(AR),graft loss,and patient death.Results:After propensity score analyses,100 ABOi KTRs and 200 matched ABOc KTRs were selected.There were no significant differences in graft and patient survival between the ABOi and ABOc groups(P=0.787,P=0.386,respectively).After using the individualized preconditioning regimen,ABOi KTRs showed a similar cumulative incidence of AR(10.0%vs.10.5%,P=0.346).Among the ABOi KTRs,the Rit-free group had a similar cumulative incidence of AR(P=0.714)compared to that of the Rittreated group.Multivariate competing risk analyses revealed that a Rit-free regimen reduced the risk of infection(HR:0.31;95%CI:0.12–0.78,P=0.013).Notably,antibody titer rebound was more common in ABOi KTRs receiving a Rit-free preconditioning regimen(P=0.013)than those receiving Rit.ABOi KTRs with antibody titer rebound had a 2.72-fold risk of AR(HR:2.72,95%CI:1.01–7.31,P=0.048).ABOi KTRs had similar serum creatinine and estimated glomerular filtration rate compared to those of ABOc KTRs after the first year.Conclusions:An individualized preconditioning regimen can achieve comparable graft and patient survival rates

关 键 词：ABO blood-group system Kidney transplantation RITUXIMAB Immunologic desensitization 

分 类 号：R699.2[医药卫生—泌尿科学]