Download PDF
Transfusionsmedizin 2013; 3(4): 191-195
DOI: 10.1055/s-0033-1350834
Kasuistik
Georg Thieme Verlag KG Stuttgart · New York

Blutgruppeninkompatible Lebendnierentransplantation einer Patientin mit spenderspezifischen Antikörpern

Successful AB0-Incompatible Living Donor Kidney Transplantation in a Patient with Donor-Specific HLA Antibodies
H. Guberina
1   Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
,
F. M. Heinemann
2   Institut für Transfusionsmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
,
A. Heinold
2   Institut für Transfusionsmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
,
M. Lindemann
2   Institut für Transfusionsmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
,
U. Eisenberger
1   Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
,
P. A. Horn
2   Institut für Transfusionsmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
,
O. Witzke
1   Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen
› Author Affiliations
Further Information

Publication History

Publication Date:
20 November 2013 (online)

Also available at
    Permissions and Reprints

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
 

  • Literatur

  • 1 Port FK et al. Comparison of survival probabilities for dialysis patients vs. cadaveric renal transplant recipients. JAMA 1993; 270: 1339-1343
    CrossrefPubMedGoogle Scholar
  • 2 Wolfe RA et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341: 1725-1730
    CrossrefPubMedGoogle Scholar
  • 3 Melancon JK et al. Paired kidney donor exchanges and antibody reduction therapy: novel methods to ameliorate disparate access to living donor kidney transplantation in ethnic minorities. J Am Coll Surg 2011; 212: 740-745 discussion 746–747
    CrossrefPubMedGoogle Scholar
  • 4 Gloor J, Stegall MD. Sensitized renal transplant recipients: current protocols and future directions. Nat Rev Nephrol 2010; 6: 297-306
    CrossrefPubMedGoogle Scholar
  • 5 Claas FH et al. The acceptable mismatch program as a fast tool for highly sensitized patients awaiting a cadaveric kidney transplantation: short waiting time and excellent graft outcome. Transplantation 2004; 78: 190-193
    PubMedGoogle Scholar
  • 6 Gloor JM, Stegall MD. ABO incompatible kidney transplantation. Curr Opin Nephrol Hypertens 2007; 16: 529-534
    CrossrefPubMedGoogle Scholar
  • 7 Patel R, Terasaki PI. Significance of the positive crossmatch test in kidney transplantation. N Engl J Med 1969; 280: 735-739
    CrossrefPubMedGoogle Scholar
  • 8 Kissmeyer-Nielsen F et al. Hyperacute rejection of kidney allografts, associated with pre-existing humoral antibodies against donor cells. Lancet 1966; 2: 662-665
    PubMedGoogle Scholar
  • 9 Colvin RB. Antibody-mediated renal allograft rejection: diagnosis and pathogenesis. J Am Soc Nephrol 2007; 18: 1046-1056
    CrossrefPubMedGoogle Scholar
  • 10 Tydén G et al. ABO-incompatible kidney transplantation and rituximab. Transplant Proc 2005; 37: 3286-3287
    CrossrefPubMedGoogle Scholar
  • 11 Morath C et al. ABO-incompatible kidney transplantation enabled by non-antigen-specific immunoadsorption. Transplantation 2012; 93: 827-834
    CrossrefPubMedGoogle Scholar
  • 12 Becker LE, Susal C, Morath C. Kidney transplantation across HLA and ABO antibody barriers. Curr Opin Organ Transplant 2013; 18: 445-454
    PubMedGoogle Scholar
  • 13 Ekstrand M et al. Preventing pregnancy: a girlsʼ issue. Seventeen-year-old Swedish boysʼ perceptions on abortion, reproduction and use of contraception. Eur J Contracept Reprod Health Care 2007; 12: 111-118
    CrossrefPubMedGoogle Scholar
  • 14 Gloor JM et al. ABO-incompatible kidney transplantation using both A2 and non-A2 living donors. Transplantation 2003; 75: 971-977
    PubMedGoogle Scholar
  • 15 Kumlien G et al. Clinical experience with a new apheresis filter that specifically depletes ABO blood group antibodies. Transfusion 2006; 46: 1568-1575
    CrossrefPubMedGoogle Scholar
  • 16 Valli PV et al. Changes of circulating antibody levels induced by ABO antibody adsorption for ABO;-incompatible kidney transplantation. Am J Transplant 2009; 9: 1072-1080
    CrossrefPubMedGoogle Scholar
  • 17 Wahrmann M et al. Anti-A/B antibody depletion by semiselective versus ABO blood group-specific immunoadsorption. Nephrol Dial Transplant 2012; 27: 2122-2129
    CrossrefPubMedGoogle Scholar
  • 18 Montgomery RA et al. Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross-match-positive recipients. Transplantation 2000; 70: 887-895
    CrossrefPubMedGoogle Scholar
  • 19 Palmer A et al. Extracorporeal immunoadsorption of anti-HLA antibodies: preliminary clinical experience. Transplant Proc 1987; 19: 3750-3751
    PubMedGoogle Scholar
  • 20 Nakanishi T et al. Current topics in therapeutic plasmapheresis. Clin Exp Nephrol 2013; DOI: 10.1007/s10157-013-0838-0.
    PubMedGoogle Scholar
  • 21 Bohmig GA et al. Immunoadsorption in severe C4 d-positive acute kidney allograft rejection: a randomized controlled trial. Am J Transplant 2007; 7: 117-121
    CrossrefPubMedGoogle Scholar
  • 22 Bartel G et al. Peritransplant immunoadsorption for positive crossmatch deceased donor kidney transplantation. Am J Transplant 2010; 10: 2033-2042
    CrossrefPubMedGoogle Scholar
  • 23 Genberg H et al. Isoagglutinin adsorption in ABO-incompatible transplantation. Transfus Apher Sci 2010; 43: 231-235
    CrossrefPubMedGoogle Scholar
  • 24 Tanabe K. Double-filtration plasmapheresis. Transplantation 2007; 84 (12 Suppl.) S30-S32
    CrossrefPubMedGoogle Scholar
  • 25 Tyden G, Kumlien G, Efvergren M. Present techniques for antibody removal. Transplantation 2007; 84 (12 Suppl.) S27-S29
    PubMedGoogle Scholar
  • 26 Wilpert J et al. Long-term outcome of ABO-incompatible living donor kidney transplantation based on antigen-specific desensitization. An observational comparative analysis. Nephrol Dial Transplant 2010; 25: 3778-3786
    CrossrefPubMedGoogle Scholar
  • 27 Slapak M et al. Renal transplantation across the ABO barrier–a 9-year experience. Transplant Proc 1990; 22: 1425-1428
    PubMedGoogle Scholar
  • 28 Tanabe K et al. Long-term results of ABO-incompatible living kidney transplantation: a single-center experience. Transplantation 1998; 65: 224-228
    PubMedGoogle Scholar
  • 29 Genberg H et al. Long-term results of ABO-incompatible kidney transplantation with antigen-specific immunoadsorption and rituximab. Transplantation 2007; 84 (12 Suppl.) S44-S47
    CrossrefPubMedGoogle Scholar
  • 30 Montgomery RA et al. ABO incompatible renal transplantation: a paradigm ready for broad implementation. Transplantation 2009; 87: 1246-1255
    CrossrefPubMedGoogle Scholar
  • 31 Fuchinoue S et al. The 5-year outcome of ABO-incompatible kidney transplantation with rituximab induction. Transplantation 2011; 91: 853-857
    CrossrefPubMedGoogle Scholar
  • 32 Haririan A et al. Positive cross-match living donor kidney transplantation: longer-term outcomes. Am J Transplant 2009; 9: 536-542
    CrossrefPubMedGoogle Scholar
  • 33 Bentall A et al. Five-year outcomes in living donor kidney transplants with a positive crossmatch. Am J Transplant 2013; 13: 76-85
    CrossrefPubMedGoogle Scholar
  • 34 Peng A, Vo A, Jordan SC. Transplantation of the highly human leukocyte antigen–sensitized patient: long-term outcomes and future directions. Transplantation Reviews 2006; 20: 146-156
    CrossrefPubMedGoogle Scholar
  • 35 Vo AA et al. Rituximab and intravenous immune globulin for desensitization during renal transplantation. N Engl J Med 2008; 359: 242-251
    CrossrefPubMedGoogle Scholar
  • 36 Lorenz M et al. Peritransplant immunoadsorption: a strategy enabling transplantation in highly sensitized crossmatch-positive cadaveric kidney allograft recipients. Transplantation 2005; 79: 696-701
    CrossrefPubMedGoogle Scholar
  • 37 Montgomery RA et al. Desensitization in HLA-incompatible kidney recipients and survival. N Engl J Med 2011; 365: 318-326
    CrossrefPubMedGoogle Scholar
  • 38 Wilde B, Pietruck F, Kribben A et al. Isoagglutinin titre adsorption: breaking the barrier in major AB0-incompatible organ transplantation. Transfus Apher Sci 2009; 41: 45-48
    CrossrefPubMedGoogle Scholar
  • 39 Min L et al. Novel rescue therapy for C4 d-positive acute humoral renal allograft rejection. Clin Transplant 2005; 19: 51-55
    CrossrefPubMedGoogle Scholar
  • 40 Ishida H et al. Evaluation of immunosuppressive regimens in ABO-incompatible living kidney transplantation – single center analysis. Am J Transplant 2007; 7: 825-831
    CrossrefPubMedGoogle Scholar
  • 41 Kayler LK, Colombe B, Farber JL et al. Successful living donor renal transplantation despite ABO incompatibility and a positive crossmatch. Clin Transplant 2004; 18: 737-742
    CrossrefPubMedGoogle Scholar