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With rapid development of organ transplantation, the issue of global organ shortage has become increasingly prominent. At present, liver transplantation is the most effective treatment for end-stage liver disease. Nevertheless, the shortage of donors has been a key problem restricting the development of liver transplantation. China is a country with a larger number of hepatitis B, and the shortage of donor liver is particularly significant. Many critically ill patients often lose the best opportunity or even die because they cannot obtain a matched donor liver in time. As a strategy to expand the donor pool, ABO-incompatible (ABOi) liver transplantation offers new options for patients who are waiting for matched donors. However, ABOi liver transplantation is highly controversial due to higher risk of complications, such as severe infection, antibody-mediated rejection (AMR), biliary complications, thrombotic microangiopathy, and acute kidney injury, etc. In this article, research progress in preoperative, intraoperative and postoperative strategies of ABOi liver transplantation was reviewed, aiming to provide reference for clinical application and research of ABOi liver transplantation.
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Objective:To explore the feasibility of applying plasma with same blood group as kidney donor to ABO incompatible kidney transplantation(ABOi-KT)preconditioning of blood group O recipients with high-titer anti-A/B preformed antibody(IgM/IgG titer ≥1∶256).Methods:A total of 15 cases of blood group O ABOi-KT recipients with high-titer anti-A/B were recruited and divided into two groups of AB( n=8)and kidney donor's blood(KD, n=7)according to plasma type for plasma exchange during preconditioning phase. Clinical data of preconditioning and post-KT were recorded. Results:They received plasmapheresis(PP)(8.1±2.5)sessions in preconditioning phase, including double plasma filtration(DFPP)(4.0±1.4)sessions and plasma exchange(PE)(4.1±2.0)sessions, PP frequency was(0.8±0.1)sessions per day. No hemolysis reaction occurred during preconditioning phase. Anti-A/B titers declined as expected and fulfilled the ABOi-KT criteria(IgM/IgG titers ≤1∶8). KT was performed successfully without antibody-mediated rejection. All of them survived with normal renal function within 90 days post-KT. Levels of serum creatinine at Day 7/30/90 post-KT were(92.9±30.4), (96.2±25.9)and(103.1±28.4)μmol/L; anti-A/B IgM titers at Day 7/30/90 post-KT 1∶1-1∶32, 1∶1-1∶64 and 1∶1-1∶32; anti-A/B IgG titers at Day 7/30/90 post-KT 1∶1-1∶64, 1∶1-1∶64 and 1∶1-1∶32 respectively. No significant differences existed in count/frequency of PP sessions, levels of serum creatinine or anti-A/B titers at each observation point between AB and KD groups( P>0.05). Conclusions:Plasma with the same blood group as kidney donor is feasible for maximizing the intensity of ABOi-KT preconditioning. Favorable outcomes may be achieved through an intensified desensitization strategy on blood group O recipients with high-titer anti-A/B preformed antibody. The potential risks and long-term outcomes should be further explored.
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Objective:To explore the potential immune mechanism of pediatric ABOi-LDLT presenting low humoral immune response to donor specific blood group antigen.Methods:From June 2013 to December 2020, clinical data were retrospectively reviewed for 29 patients of long-term surviving pediatric ABOi-LDLT.There were A to O ABOi-LDLT( n=10)and B to O ABOi-LDLT( n=19). Graft types included left lateral lobe( n=26)and left hemi-liver( n=3). The median age of liver transplantation was 10 months, the median weight 8.0 kg and the median follow-up time 41.9 months.The titers of donor specific blood group antibodies and non-donor specific blood group antibodies(IgG, IgM)were continuously monitored before transplantation and at 1, 3, 6, 12, 24, 36 months post-transplantation.Protocol or event-based liver biopsy was performed to determine whether or not there was antibody-mediated rejection. Results:The titer of donor specific blood group antibody in recipients was significantly lower than that of non-donor specific blood group antibody( P<0.001). Among 18 protocol liver pathological biopsies, two cases were C4d positive for vascular endothelium.Five abnormal event-based liver biopsies were completed and one was C4d positive in bile duct endothelium.No pathological sign of typical blood group antibody mediated antigen-antibody complex mediated cascade immune reaction was detected in liver pathological biopsy.Typical pathological signs of blood group antibody mediated rejection were absent in protocol liver biopsy. Conclusions:Donor specific blood group antibody is expressed at a low level in pediatric ABOi-LDLT recipients.It presents as incomplete immune tolerance to donor specific blood group antigen.
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Objective:To explore the critical value of different blood group antibody titration in ABO blood group incompatible kidney transplant(ABOi-KT)recipients by tube and gel methods to provide rationales for selecting the threshold value of antibody titration before ABOi-KT.Methods:From January 2019 to April 2021, 681 blood group antibody titrations were performed for 214 ABOi-KT recipients.There were type A( n=135), type B( n=168)and type O( n=378). The difference, correlation and consistency of two methods were statistically analyzed. Results:Tube method was 2 gradients lower than gel method(4-fold dilution)and the results were significantly different( P<0.000 1). Spearman's test indicated that the results of two methods were significantly correlated( P<0.000 1). The results of intraclass correlation coefficient showed that the consistency of two methods was general for type A recipients(ICC=0.640), decent for type B recipients(ICC=0.751)and poor for type O recipients(ICC<0.4). When the critical value of tube method was set, titration of type A anti-B was 16, titration of type B anti-A 8 and titration of type O anti-A/B 8.And the corresponding critical values of gel was type A anti-B 32, type B anti-A 16 and type O anti-A/B 16. Conclusions:The results of ABO blood group IgM antibody titration by gel and tube methods are correlative.And gel method is recommended for more stable and reproducible results.
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Resumen El trasplante renal con donante vivo (DV) ABO incompatible (ABOi) permite aumentar el número de donantes y reducir el tiempo en lista de espera. Los objetivos de este estudio fueron: comparar la supervivencia del injerto, del paciente, los factores de riesgo de rechazo y las complicaciones durante el primer año post-trasplante en los pacientes que recibieron un trasplante DV ABOi entre 2014 y 2019 en nuestra ins titución, emparejados según sexo, edad y riesgo inmunológico con un grupo control de trasplantados DV ABO compatibles (ABOc) en el mismo periodo. Se incluyeron 13 pacientes en cada grupo. No se hallaron diferencias significativas entre los ABOi vs ABOc en la incidencia de retardo de la función del injerto (n = 0 vs. 1), sangrado (0 vs. 0), infecciones (13 vs. 13), rechazo celular (1 vs. 3) y rechazo humoral (4 vs. 3) en el primer año post-trasplante. La tasa de rechazo en los pacientes ABOi no parece tener relación con la incompatibilidad sanguínea, ni se hallaron otros factores de riesgo asociados a rechazo. La supervivencia global de los pacientes fue del 100% en ambos grupos, y la del injerto fue del 92.3% en ABOi y 100% en ABOc (p = 1). El trasplante renal ABOi es una adecuada opción factible en nuestro medio para quienes que no cuentan con donantes compatibles.
Abstract The ABO incompatible (ABOi) living donor (LD) kidney transplant allows increasing the number of donors and reducing the time on the waiting list. The objectives of this study were to compare graft survival, patient survival, rejection risk factors and complications during the first year p ost-transplantation in patients who received an ABOi LD kidney transplant between 2014 and 2019 in our institution, matched according to sex, age and immunological risk with a control group of ABO compatible (ABOc) LD kidney transplants in the same period. Thirteen patients were included in each group. No significant differences were found between ABOi and ABOc in the incidence of delayed graft function (n = 0 vs. 1), bleeding (0 vs. 0), infections (13 vs. 13), cellular rejection (1 vs. 3) and humoral rejection (4 vs. 3) in the first year after transplantation. The rejection rate in ABOi do not seem to be related to blood incompatibility. No risk factors associated with rejection were found. Overall survival of patients was 100% in both groups, and graft survival was 92.3% in ABOi and 100% in ABOc (p = 1). ABOi kidney trans plantation is an adequate feasible option in our environment for those who do not have compatible donors.
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【Objective】 To study the expression level of ABO blood group antigen on the surface of platelets of blood donors. 【Methods】 A total of 506 donors with normal ABO blood group were selected to analyze the ABO antigen on platelets by flow cytometry. Among them, 30 donors were selected to monitor the changes of ABO antigen on platelets during the storage period, and the remaining 476 to analyze the expression difference of ABO antigen among blood donors. 【Results】 The ABO antigen on platelets of each sample fluctuated slightly but was relatively stable over 1~7 days in vitro. According to MFI values, the donors were divided into low-, moderate- and high- expression groups, with the average frequency of 59.6%, 35.5% and 4.9%, respectively. The A and B antigens of blood group AB platelets exhibited a competitive co-expression pattern. 【Conclusion】 Most individuals have low-expression phenotype of ABO antigen on platelets and can be potential platelet donors for ABO-incompatibility transfusion, which is helpful to improve platelets transfusion strategy.
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Objective To explore the feasibility and safety of kidney transplantation in highly sensitized recipients by using ABO incompatible (ABOi) and yet human leucocyte antigen (HLA) supremely matched deceased donor kidneys and summarize the literatures as well .Methods A kidney graft from a deceased donor of blood type B was transplanted to a highly presensitized recipient of blood type O to achieve a HLA matching number of 7 /8 in May 2018 .Donor specific antibody (DSA) against HLA was negative and baseline anti-B IgM 1 : 16 . Plasmapheresis (PP) plus intravenous immunoglobulin (IVIG) plus anti-CD20 antibodies were offered on operation day .Clinical data was retrospectively analyzed .Results Renal graft functioned immediately and achieved a normal level of serum creatinine (SCr) at d2 after transplantation .However ,the value of SCr increased to 131 μmol/ l at d9 with a simultaneously elevated level of anti-B IgM from 1:2 at d7 to 1:16 .A renal graft biopsy at d11 showed mild inflammation in peritubular capillaries and focal tubulitis with minimal interstitial infiltration .No de novo DSA was detected .Then PP plus IVIG were then given twice ,followed by an administration of IVIG alone for another 2 days (20 g/d) .After treatments ,SCr had a range of 120- 140 μmol/l and anti-B IgM level decreased to 1:4 at d21 post-transplantation .During a follow-up of 6 months ,there was no onset of proteinuria or infection and the last value of SCr was 114 μmol/L . Conclusions In HLA highly sensitized recipients awaiting for transplant opportunities , successful prevention of HLA antibodies-mediated rejection may be achieved by using ABO incompatible and yet HLA compatible deceased donors .
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A 77-year-old female patient who was suspected to have had an acute hemolytic transfusion reaction was admitted to the emergency room. She received one unit of type A red blood cells in a type B patient during a total knee arthroplasty operation at another medical institution. ABO-incompatible transfusion was carried out due to an identification error between the patient and blood product. At the time of admission, acute hemolytic reaction, lactic acidosis, and disseminated intravascular coagulation were observed. She was admitted to the intensive care unit and received continuous renal replacement therapy. She maintained renal function and was moved to the general ward on the 7th day. Complications such as pulmonary edema, gastrointestinal bleeding, and ischemic colitis persisted, and the patient died on the 111th after admission. This case is the first report of death due to an ABO-incompatible transfusion in Korea. Efforts to establish a safe transfusion environment are necessary not only at individual medical institutions but also at the national level.
Subject(s)
Aged , Female , Humans , Acidosis, Lactic , Arthroplasty, Replacement, Knee , Blood Transfusion , Colitis, Ischemic , Disseminated Intravascular Coagulation , Emergency Service, Hospital , Erythrocytes , Hemorrhage , Intensive Care Units , Korea , Patients' Rooms , Pulmonary Edema , Renal Replacement Therapy , Transfusion ReactionABSTRACT
An ABO-incompatible transfusion is a very rare event but it can cause severe adverse effects, including death. The prognosis is affected by various factors, such as the volume of infusion, underlying diseases, and immunologic state. Until now, however, there has been no consensus regarding the treatment of an ABO-incompatible transfusion except for conservative treatment. A 57 year-old male patient visited the authors' emergency unit with multiple trauma due to a car accident. He had a deep laceration on his left neck accompanied by severe bleeding. Because of his low blood pressure and low hemoglobin level due to bleeding, an emergency transfusion was attempted. Unfortunately, one unit of RBC was transfused incorrectly into the patient due to a clerical error during the identification of the patient. The patient was typed as O, RhD positive; the RBC administered was A, RhD positive. After the transfusion, the patient showed an acute hemolytic transfusion reaction due to gross hematuria. Plasma exchange was attempted and medical treatment with high dose steroid with diuretics was done simultaneously. Two cycles of plasma exchange were done and the patient appeared to recover from the acute adverse effects of the transfusion. The plasma exchange was stopped and medical treatments for the transfusion reactions were maintained for ten days. The patient recovered fully and was discharged after one month. Based on this case, although more studies are necessary for approval as a standard therapy, this case suggests that immediate plasma exchange with medical treatment can be very helpful for eliminating the isoagglutinins in ABO-incompatible transfusions.
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Humans , Male , Clergy , Consensus , Diuretics , Emergencies , Emergency Service, Hospital , Hematuria , Hemorrhage , Hypotension , Lacerations , Multiple Trauma , Neck , Plasma Exchange , Plasma , Prognosis , Transfusion ReactionABSTRACT
Objective To compare the flow cytometry versus test tube method in detecting antibody titer in ABO blood type,and try to establish a standard method using flow cytometry to provide insight in ABO incompatible kidney transplantation and therapeutics.Methods The ABO blood type titers of anti-IgM-A/B and anti-IgG-A/B in 30 serum samples from renal allograft recipients were measured by flow cytometry.The results were compared with those determined by test tube method.Results The titers by cytometry significantly higher than those by test tube method (P＜0.05).Conclusion The sensitivity of flow cytometry is significantly higher than test tube method,and flow cytometry can precisely monitor the ABO blood titers in renal allograft recipients,which can provide better medical advice in clinical treatment and therapeutics.
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La incompatibilidad de grupo sanguíneo ABO y la sensibilización al HLA constituyen grandes barreras a vencer en pro de la óptima utilización de riñones de donante vivo. Describimos en nuestro medio el primer trasplante renal exitoso ABO incompatible en un paciente de 24 años, retrasplantado renal, altamente sensibilizado (PRA: 89%) y sin opción alguna en disponer de donantes cadavéricos ni familiares. Sin embargo, su único donante vivo HLA compatible era de grupo sanguíneo A incompatible con el grupo O del receptor. El paciente requirió de un régimen precondicionante consistente en recambios plasmáticos, rituximab, imunoglobulina y terapia inmunosupresora cuádruple, a fin de reducir los títulos elevados de isoaglutininas anti A de 1:128 a niveles de seguridad de 1:8, para el éxito del trasplante. Este fue realizado en Coordinación con la Unidad de Trasplante Renal del Hospital Clínic de Barcelona España (HCB). La ausencia de rechazo mediado por isoaglutininas muestra el potencial beneficio del protocolo al remover los anticuerpos anti grupo sanguíneo. A los dos años del trasplante, la función renal se mantiene estable con niveles de creatinina 1,5 mg%. Concluimos que el trasplante renal ABO incompatible (ABOi) es opción viable para pacientes cuyo único donante sea grupo sanguíneo incompatible, y entre nosotros representa esperanzadora fuente de órganos.
ABO blood group incompatibility and HLA sensitization are major barriers that need to be overcome in order to make optimum use of kidneys from living donors possible. We report the first successful ABO- incompatible kidney transplant in a 24-year old, highly sensitized (panel reactive antibodies (PRA) 89% kidney retransplantation patient, who lacked any option to get a cadaveric or family donor. However, the patient's sole HLA-compatible living donor had group A blood incompatible with the recipient's O blood group. The < patient required a pre-conditioning regime that consisted of plasma exchange, rituximab, immunoglobulin, and quadruple immunosuppressive therapy in order to reduce high titers of anti-A isoagglutinins from 1:128 to a safe level of 1:8, for successful transplant. This was performed in coordination with the Renal Transplant Unit of Hospital Clinic de Barcelona (HCB), Spain. Absence of rejection mediated by isoagglutinins shows the potential benefit of a protocol consisting in removing antibodies from the anti-blood group. Two yearsafter transplantation, the kidney function remains stable, with creatinine levels of 1.5 mg%. We conclude that an ABO-incompatible kidney transplant is a viable option for patients whose only donor has blood of an incompatible blood group and for us this represents a hope-inspiring source of organs .
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Objective To compare the clinical efficacy between pediatric ABO-incompatible liver transplantation (ILT) and ABO-compatible liver transplantation (CLT) by Meta-analysis. Methods Relevant studies published until May 2017 were electronically retrieved from PubMed, Embase, Cochrane library, China national knowledge internet (CNKI),Wanfang and VIP databases. According to the inclusion and exclusion criteria, the publications eligible were screened and clinical data were extracted. Meta-analysis was performed using the random or fixed effect model analyses with Review Manager 5.3 statistical software. Results Eleven retrospective cohort studies in English were selected. Meta-analysis demonstrated that the postoperative 1-year survival rate of the recipients in the ILT group was significantly lower than that in the CLT group [odds ratio (OR)=0.64, 95% confidence interval (CI) 0.49-0.83, P=0.0007)]. In the ILT group, the incidence of postoperative rejection reactions was considerably higher compared with that in the CLT group (OR=1.96,95% CI 1.03-3.72, P=0.04). No statistical significance was observed in the postoperative 3- and 10-year survival rate of the recipients, 1-, 3- and 10-year survival rate of the graft and the incidence of postoperative biliary tract complications between two groups (all P>0.05). Conclusions Compared with their CLT counterparts, the 1-year survival rate of the ILT recipients is lower, whereas the incidence of rejection reactions is higher. However, the long-term survival rate of both the recipient and graft and the incidence of biliary tract complications do not significantly differ between CLT and ILT. ILT is a relatively ideal option for emergent patients or those lacking of liver graft with compatible blood group for a long period of time.
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Objective To analyze the clinical efficacy and outcomes of adult patients who underwent ABO-incompatible living donor liver transplantation.Methods The clinical data of 7 patients who underwent ABO-incompatible living donor liver transplantation at the Henan Provincial People's Hospital and Zhengzhou People's Hospital from January 2013 to December 2015 were analyzed retrospectively.Age,gender,primary disease,blood type antibody level,graft volume/standard liver volume (GV/SLV),postoperative complications and prognosis were analyzed.Results The recipients' average GV/SLV was 52.0％.There were 4 recipients who underwent splenectomy,including 3 patients who underwent the procedure concurrently,and one patient who underwent the procedure a few years before,the liver transplantation.Seven recipients were treated with plasmapheresis,Rituximab and Basiliximab.No patients experienced acute rejection during the perioperative period,and the 1-year survival rate was 85.7％ (6/7).Conclusion ABOincompatible liver transplantation in adult living donor can have favorable clinical outcomes using appropriate preoperative evaluation for recipients,optimized surgical procedures,pretransplant plasmapheresis,and perioperative Rituximab,Basiliximab injection and intravenous immunoglobulin administration.
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A 47-year-old man developed chronic alcoholic liver cirrhosis and end-stage renal disease. He underwent blood-type-compatible liver transplantation with a graft from his daughter. After 8 months, sequential ABO-incompatible (ABOi) kidney transplantation was performed, with his brother as the donor (A to O). The patient had anti-A antibody titers (1:256). We performed pretransplant desensitization, including administration of rituximab, mycophenolate mofetil, tacrolimus, and prednisolone 2 weeks before the scheduled transplantation, and plasmaphresis (PP) and administered an intravenous immunoglobulin injection. The patient underwent PP before kidney transplantation until the anti-A antibody titer was <1:8. The patient achieved normal renal function within 4 posttransplantation days. Postoperative bleeding (diffuse hemorrhage) requiring additional blood transfusions and radiological intervention (drainage procedure) occurred 9 days after transplantation. The patient was discharged on day 20 of hospitalization. Nine months after the kidney transplantation, the recipient's and donor's liver and kidney functions were normal. ABOi renal transplantation after liver transplantation can be successfully performed in patients with high baseline anti-ABO antibody titers after preconditioning with rituximab and PP, and quadruple immunosuppressive therapy. However, caution is required regarding an increased risk of bleeding complications.
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Humans , Middle Aged , Blood Transfusion , Hemorrhage , Hospitalization , Immunoglobulins , Kidney , Kidney Failure, Chronic , Kidney Transplantation , Liver , Liver Cirrhosis, Alcoholic , Liver Transplantation , Nuclear Family , Prednisolone , Rituximab , Siblings , Tacrolimus , Tissue Donors , TransplantsABSTRACT
The Japanese ABO-Incompatible Transplantation Committee officially collected and analyzed data on pediatric ABO-incompatible living-donor kidney transplantation in July 2012. The age of a child was defined as <16 years, and 89 children who had undergone ABO-incompatible living-donor kidney transplantation from 1989 to 2011 were entered in a registry. These data were presented as the Japanese registry of pediatric ABO-incompatible living-donor kidney transplantation at the regional meetings of the International Pediatric Transplantation Association (IPTA) in Nagoya in September 2012 and in Sao Paulo in November 2012.
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , ABO Blood-Group System/blood , Blood Group Incompatibility/blood , Kidney Transplantation/mortality , Living Donors/statistics & numerical data , Blood Group Incompatibility/complications , Blood Group Incompatibility/mortality , Graft Rejection , Graft Survival , Japan/epidemiology , Kidney Transplantation/adverse effects , Kidney Transplantation/statistics & numerical data , Plasmapheresis , Retrospective Studies , Survival RateABSTRACT
Immunologic responses of infants and younger children differ from those of adults. Therefore, application of different pretransplant strategies for antibody depletion in younger ABO-incompatible transplant recipients is appropriate. A 12-month-old male infant with end stage renal disease after acute tubular necrosis was scheduled to undergo kidney transplantation from an ABO-incompatible living donor. He did not undergo pretransplant plasmapheresis, as the titer of the anti-ABO antibody was less than 1:4. After kidney transplantation, posttransplant renal function and anti-ABO titers were stable until posttransplant 2 years.
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Adult , Child , Humans , Infant , Male , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Living Donors , Necrosis , Plasmapheresis , TransplantationABSTRACT
BACKGROUND/AIMS: Kidney transplantation (KT) is the best treatment for end-stage renal disease patients. Although previous studies have demonstrated that the clinical outcome following living related (LR) KT is better than that following unrelated (LUR) KT in ABO-compatible KT recipients, recent studies showed no differences in clinical outcomes between the two treatments. In this study, we compared the clinical outcomes of LR and LUR KT in ABO-incompatible KT recipients. METHODS: From January 2011 to August 2013, 19 cases of ABO-incompatible KT were analyzed retrospectively. Eight kidneys (7 cases of parent-offspring and 1 case of siblings, Group 1) were donated from living-related donors and 11 (all spousal donors, Group 2) from living-unrelated donors. We investigated patient survival, graft survival, acute rejection, graft function, and complications. RESULTS: On Kaplan-Meier analysis, patient and graft survival during follow-up were 87.5% and 87.5% in Group 1; both were 100% in Group 2. Acute rejection, graft function, and medical and surgical complications were not significantly different between the two groups. CONCLUSIONS: The short-term clinical outcomes between LR and LUR KT in ABO-incompatible KT recipients were equivalent. Most domestic cases of LUR KT are from spousal donors and the spousal donor will be a major donor in ABO-incompatible KT patients.
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Humans , Follow-Up Studies , Graft Rejection , Graft Survival , Kaplan-Meier Estimate , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Retrospective Studies , Siblings , Tissue Donors , TransplantationABSTRACT
BACKGROUND: The majority of patients undergoing stem cell transplantation (SCT) require a blood transfusion until the complete engraftment. Because blood transfusion rules for patients with ABO-incompatible SCT are complicated, we developed an ABO-incompatible transfusion management system (ABO-ITMS) for accurate blood transfusion and improved manageability. METHODS: A committee composed of medical doctors, technicians, and a programmer developed ABO-ITMS during the eight months from July 2013 to February 2014. The program has been linked with other databases, including clinical and laboratory databases and resulted in a new subsystem of the health information system. Server computer's operating system was Window Server 2008, and the database manager program was Oracle 11g. Programming language was ASP.Net (VBScript, C #), and the server and client computer were used to connect to the web server using a web browser. RESULTS: ABO-ITMS was designed to follow three main steps by hematologic oncology clinic, laboratory physician, and blood bank. In the first step, a hematologic-oncology clinic doctor inputs SCT recipients' data and appropriate ABO group for each phase of post-transplantation. Laboratory physician enters the isoagglutinin titer and ABO group at the second step. Finally, blood bank workers enter the results of type, screening, and antibody identification. The patient's SCT information and the previous immunohematologic test results are shown on the screen. CONCLUSION: ABO-ITMS can replace the existing complicated system and workflow. ABO-ITMS will contribute to reducing medical error and improving quality of SCT recipient care.
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Humans , Blood Banks , Blood Transfusion , Health Information Systems , Mass Screening , Medical Errors , Programming Languages , Stem Cell Transplantation , Web BrowserABSTRACT
Objective To establish a hyperacute rejection model in ABO-incompatible renal allotransplantation in nonhuman primates.Method ABO-incompatible renal transplantation was performed using blood group B cynomolgus monkeys as recipients and blood group A cynomolgus monkeys as donors.The transplants were distributed into 2 groups according to whether the recipient monkey was presensitized or not:(1) non-presensitized control group (n =1),not receiving any pretreatment; (2) KLH-conjugated blood group antigen A (KLH-A) presensitized group (n =3),being presensitized by subcutaneous injection of KLH-A 2 weeks prior to ABO-incompatible renal transplantation.The serum anti-blood group A antibody levels were measured using a FACS method.The graft survival time was observed and the pathologic studies were performed using the endpoint renal graft tissue samples.Result In non-presensitized control group,no hperacute rejection was observed during the surgery.With the traditional CsA triple therapy,the renal allograft survived was more than 30 days without obvious rejection,and the serum creatinine level was 263 μmol/L at day 30.After the presentization with KLH-A,recipient monkeys of KLH-A presensitized group had a markedly increased anti-A antibody levels and rapidly rejected the renal allografts from blood group A donors within 1 h after the reperfusion,which was demonstrated to be a hyperacute rejection with the pathologic studies.Conclusion The strategy of presensitization with KLH-conjugated blood group antigen significantly increases the corresponding blood group antibodies and allows the establishment of a hyperacute rejection model in ABO-incompatible renal allotransplantation in nonhuman primates.
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BACKGROUND: Kidney transplantation (KT) is the optimal treatment for end stage renal disease. However, the relative shortage of organs for transplantation (from human leukocyte antigen- or ABO incompatible [ABOi] living donors) has led to ABOi KT as an accepted method to expand the pool of living kidney donors. To date, reports of the outcomes of ABOi KT are limited; therefore this study aims to evaluate the outcomes of ABOi KT in recipients. METHODS: We identified 45 patients who underwent live-donor ABOi KT between February 2007 and November 2011 at Maryknoll Medical Center. All of them were treated according to the scheduled protocol of plasmapheresis with low dose intravenous immunoglobulin, and low dose rituximab- or tacrolimus-based triple immunosuppressant regimens. Clinical parameters and the incidence of rejections in these patients were analyzed. RESULTS: We had three cases (6.6%) of biopsy-proven acute antibody-mediated rejections and one case (2.2%) of acute cellular rejection, all of which were successfully treated. The median follow-up duration was 20 months (range, 2~59). Antibody depletion was scheduled according to baseline anti-ABO antibody titer (tube method: median immunoglobulin G titer/immunoglobulin M titer 64 [range, 8~4,096]/16 [range, 2~256], respectively). Although there was no patient death, one patient lost his graft due to nonadherence to immunosuppressants. CONCLUSIONS: Our analysis of ABOi KT has shown excellent and promising outcomes. These practices may therefore represent an acceptable option for expanding the pool of living kidney donors.