Blutgruppeninkompatible Lebendnierentransplantation einer Patientin mit spenderspezifischen Antikörpern

Zusammenfassung

Die Nierentransplantation ist die Therapie der Wahl für terminal nierenkranke Patienten. Immunisierte Patienten mit Antikörpern gegen Histokompatibilitätsantigene (HLA) des Spenders haben nur eine geringe Chance, ein passendes Organ im Rahmen der regulären Warteliste zu bekommen. Die Lebendnierentransplantation stellt trotz möglicher immunologischer Hürden, wie der Blutgruppeninkompatibilität oder spenderspezifischen Antikörpern, häufig die einzige Alternative für diese Patienten dar. Lange Zeit wurden Antikörper gegen die Blutgruppe oder die HLA-Merkmale des Spenders als absolute Kontraindikation gegen eine Nierentransplantation angesehen. Das Vorliegen beider Antikörper beim Empfänger führt zu einer humoralen Abstoßung und schädigt so das Transplantat. Im Rahmen der Lebendspende kommen zunehmend extrakorporale Desensibilisierungsverfahren zum Einsatz, mit denen zirkulierende Antikörper entfernt werden können. Erst diese Verfahren machen eine Transplantation über immunologische Barrieren hinweg möglich. Wir berichten im Nachfolgenden über die erfolgreiche blutgruppeninkompatible Lebendnierentransplantation einer jungen Patientin mit spenderspezifischen Antikörpern.

Abstract

Transplantation is the treatment of choice for end stage renal disease. Sensitized patients on the kidney waiting list with antibodies directed against donor human leukocyte antigens have the least chance for an organ. For these patients a living kidney donation is despite potential immunological burdens – like incompatible blood group or donor specific antibodies – the sole alternative. These two immunological burdens have been considered as an unacceptable risk and an absolute contraindication for renal transplantation. Both can lead to an acute humoral rejection and injure the graft. In the setting of living donation extracorporeal desensitization techniques for removing harmful antibodies have been developed making transplantation over immunologic barriers possible. We here describe the successful blood group-incompatible living kidney transplantation of a patient with donor specific antibodies.

Schlüsselwörter

Nierentransplantation - Lebendnierenspende - AB0-Inkompatibilität - spenderspezifische Antikörper - Desensibilisierung

Key words

kidney transplantation - living kidney donation - AB0 incompatibility - donor specific antibodies - desensitization

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