ABO. ABO ABO ABO ABO ABO ABO ABO ABO. Key words ABO. Alexandre ABO ABO. double filtration plasmapheresis, DFPP. antibody-mediated rejection, AMR
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1 ABO ABO ABO ABO ABO ABO ABO ABO ABO ABO.. ABO ABO. ABO. ABO ABO Key words ABO ABO A B antibody-mediated rejection, AMR Alexandre ABO double filtration plasmapheresis, DFPP
2 ABO ABO n ABO n p-value R..... Sex M / F / / D.... ns Sex M / F / / R.... ns HLA-AB.... ns DR.... ns RD mean SD ABO ABO.. ABO ABO ABO.A B AB.. ABO.... ABO ABO ABO Wilcoxon p. R Age / Sex D HLA-AB DR LCT / M CGN / A O neg / F PCK / AB A neg /F DM / AB B neg / M IgA DM / B A neg / F PCK / A B neg / M CGN / B O neg /M / A B neg /F DM / AB O T/B w, c pos /M DM / B O neg /F / B O neg CGN: chronic glomerulonephritis, PCK: polycystic kidney, DM: diabetes mellitus, LCT: lymphocyte cytotoxicity test, neg: negative, T/B w,c pos: T&B cell warm&cold positive
3 A A B B AB AB O O O A B AB A AB B AB Day- Tac. / / day, MMF / /day, MP /day DFPP PEX BXM basiliximabday, Tac MMF MP ABO ABO A O A B AB O A AB B B AB A ABO Tac. / /day MMF / /day MP /day DFPP plasma exchange, PEXDFPP PEX IgG IgM CD BXM / CD rituximab MP /day Day- Tac. / /day MMF / /day BXM BasiliximabDay, Tac MMF MP
4 ABO / /day /day Tac MMF MP native GVHD. Gy/ ABO Tac. / / day CYA / / day MMF / /day BXM / MP /day Tac CYA MMF MP ABO acute rejection, AR ABO A/ B IgG, IgM R Age/Sex A/B /M A A IgM IgG DFPP PEX /F B B IgM IgG /F A A IgM IgG /M B B IgM IgG /F A A IgM IgG /M B B IgM IgG /M A A IgM IgG / F A/B A IgM IgG B IgM IgG /M B B IgM IgG /F B B IgM IgG DFPP PEX PCK DFPP PEX DFPP PEX DFPP PEX PCK DFPP PEX DFPP PEX MMF LCT neg MMF LCT neg A/B DFPP PEX DFPP PEX DFPP PEX DFPP: double filtration plasmapheresis, PEX: plasma exchange, MMF: mycophenolate mofetil, LCT: lymphocyte cytotoxicity test, neg: negative
5 IgG IgM A/ B IgG, IgM DFPP PEX IgG IgM Polycystic kidney, PCK rebound DFPP PEX IgG IgM AB O lymphocyte cytotoxicity test, LCT T B MMF / day LCT T B MMF LCT T B DFPP PEX B IgG ABO. ABO.. ABO diffuse B cell lymphoma, EB MP ABO ABO CAN AR ABO AR. ABO AR. AR / AR AR
6 ABO R Age/Sex AR CMV-Ag /Cr A/B /M clipping /Cr. A IgM IgG /F /Cr. B IgM IgG /F diffuse B cell lymphoma CR /Cr. dwf /M /Cr. B IgM IgG /F /Cr. A IgM IgG /M /Cr. B IgM IgG /M AR MP AR /Cr. A IgMIgG /F CMV-Ag /, + GCV /Cr. A IgMIgG B IgM IgG /M AR + /Cr. B IgM IgG MP /F /Cr. B IgM IgG R: recipient, AR: acute rejection, CMV-Ag: cytomegalovirus antigenemia, :,. Cr: creatinine, dwf: death with functioning graft, GCV: ganciclovir AR DSG CDCD CMV ABO CMV. GCV ABO CMV., CMV GCV ABO G-CSF clipping ABO G-CSF VUR ABO ABO ABO ABO ABO
7 AMR memory B cell, plasma cell AMR AMR accommodation ABO accommodation ABO ABO ABO IgG IgM ABO rebound LCT T B LCT rebound high responder CD B CD rituximab ABO rituximab rituximab complement-dependent cytolysis, CDC antibody-dependent cell-mediated cytotoxicity, ADCC B rituximab B ABO AMR rituximab rituximab ABO.
8 ABO ABO rituximab ABO rituximab ABO ABO CMV Alexandre GPJ, Squifflet JP, De Bruyere M et al.: Splenectomy as a prerequisite for successful human ABO-incompatible renal transplantation. Transplant Proc : -,. Takahashi K, Tanabe K, Ooba S et al.: Prophylactic use of a new immunosuppressive agent, deoxyspergualin, in patients with kidney transplantation from ABO-incompatible or preformed antibody positive donors. Transplant Proc : -,. Sonnenday CJ, Warren DS, Cooper M et al.: Plasmapheresis, CMV hyperimmune globulin, and anti-cd allow ABO-incompatible renal transplantation without splenectomy. Am J transplant : -,. Tyden G, Kumlien G, Genberg H et al.: ABOincompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant : -,. Gloor JM, Lager DJ, Fidler ME et al.: A comparison of splenectomy versus intensive posttransplant antidonor blood group antibody monitoring without splenectomy in ABO-incompatible kidney transplantation. Transplantation : -, Takahashi K, Saito K, Takahara S et al.: Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan. Am J Transplant : -,. Takahashi K: Accommodation in ABOincompatible kidney transplantation: Why do kidney grafts survive? Transplant Proc Suppl : S- S,. Takahashi K: A new concept of accommodation in ABO-incompatible kidney transplantation. Clin Transplant Suppl : -,. Sawada T, Fuchinoue S and Teraoka S: Successful A -to-o ABO-incompatible kidney transplantation after a preconditioning regimen consisting of anti-cd monoclonal antibody infusions, splenectomy, and doublefiltration plasmapheresis. Transplantation : -,. Sawada T, Fuchinoue S, Kawase T et al.: Preconditioning regimen consisting of anti-cd monoclonal antibody infusions, splenectomy and DFPP-enabled non-responders to undergo ABO-incompatible kidney transplantation. Clin Transplant : -,. Johnson P, Glennie M: The mechanisms of action of rituximab in the elimination of tumor cells. Semin Oncol : -,. Tyden G, Donauer J, Wadstrom J et al.: Implementation of a protocol for ABO-incompatible
9 kidney transplantation-a three-center experience with consecutive transplantations. Transplantation : -,. Saito K, Nakagawa Y, Suwa M et al.: Pinpoint targeted immunosuppression: anti-cd/ MMF desensitization with anti-cd in successful ABO-incompatible kidney transplantation without splenectomy. Xenotransplantation : -,. Mitsuhata N, Ito S, Fujita R et al.: ABOincompatible renal transplantation without splenectomy between husband and wife among the ever oldest patients. Am J Transplant : -,.
10 Jichi Medical University Journal ABO-incompatible living kidney transplantation at Jichi Medical University Hospital Nobuo Ishikawa, Yasunaru Sakuma, Takehito Fujiwara, Naoshi Miyamoto, Akinori Nukui, Masahiro Yashi, and Takashi Yagisawa Abstract ABO-incompatible living kidney transplantation LKT has been perfomed to widen the indications for kidney transplantation in Japan. We have been performing ABO-incompatible LKT at Jichi Medical University Hospital since April. This study was designed to summarize our experience with ABOincompatible LKT. We performed cases of LKT between April and December. Of these, patients group ABO-IC;. % received kidneys from ABO-incompatible donors and patients group ABO-C;. % received kidneys from ABO-compatible donors. During the induction phase of ABO-IC, tacrolimus Tac, mycophenolate mofetil MMF, and methylprednisolone MP were used for a -day period of pretransplantation immunosuppression. Basiliximab BXM was administered on the day of surgery and postoperative day. In all ABO-IC patients, plasmapheresis was performed to remove anti- AB antibodies prior to LKT, and splenectomy was performed at the time of or before LKT. In ABO-IC, patient with functioning graft died due to malignant lymphoma diffuse B-cell lymphoma, EBV-non related. In ABO-C, patient with functioning graft died due to traumatic subdural hematoma and hemodialysis was re-initiated in patient following allograft failure. Patient and graft survival rates at the end of March were % and. % for ABO-IC and % and. % for ABO-C, respectively. Incidence of acute rejection was. % in ABO-IC and. % in ABO-C. No patients experienced any serious complications. Our results demonstrate that LKT from an ABO-incompatible donor using a -day period of pretransplantation immunosuppression with Tac, MMF and MP is equivalent to LKT from an ABOcompatible donor. According to the Japanese Renal Transplant Registry, transplantations were performed using living donors in Japan in. Among these, kidneys. % were donated from ABO-incompatible donors. In response to the shortage of deceased donors, ABO-incompatible LKT will spread in Japan. Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital
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